Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 16, 2023; 11(11): 2576-2581
Published online Apr 16, 2023. doi: 10.12998/wjcc.v11.i11.2576
Autoimmune encephalitis after surgery for appendiceal cancer: A case report
Yan-Hui Mao, Lu Li, Li-Ming Wen, Jia-Min Qin, Ya-Ling Yang, Li Wang, Fan-Rong Wang, Yi-Zhou Zhao
Yan-Hui Mao, Lu Li, Li-Ming Wen, Jia-Min Qin, Ya-Ling Yang, Li Wang, Department of Gastroenterology, Sichuan Mianyang 404 Hospital, Mianyang 621000, Sichuan Province, China
Fan-Rong Wang, Department of Pathology, Sichuan Mianyang 404 Hospital, Mianyang 621000, Sichuan Province, China
Yi-Zhou Zhao, Department of Medical Imaging, Sichuan Mianyang 404 Hospital, Mianyang 621000, Sichuan Province, China
Author contributions: Mao YH followed-up the patient and wrote the paper; Li L participated in the treatment and management of patient; Wang FR, Zhao YZ and Wang L collected the data; Qin JM and Yang YL helped to correct the article; Wen LM conceptualized the idea and finalized the manuscript; All authors have read and approve the final manuscript.
Informed consent statement: Since the patient is deceased, informed written consent was obtained from the relatives of patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Li-Ming Wen, MD, Chief Doctor, Department of Gastroenterology, Sichuan Mianyang 404 Hospital, No. 56 Yuejin Road, Mianyang 621000, Sichuan Province, China. scmy404yy@sina.com
Received: February 19, 2023
Peer-review started: February 19, 2023
First decision: February 28, 2023
Revised: March 7, 2023
Accepted: March 17, 2023
Article in press: March 17, 2023
Published online: April 16, 2023
Processing time: 45 Days and 21.5 Hours
Abstract
BACKGROUND

Primary cancer of the appendix is rare and often difficult to diagnose preoperatively due to the lack of specific clinical symptoms. Autoimmune encephalitis (AIE) is the most common cause of non-infectious encephalitis. The etiologies of AIE include tumors (paraneoplastic), infections (parainfections), or recessive infections. The tumors that have been reported to cause AIE include thymomas, ovarian teratomas, lung cancers, and breast cancers. However, there are no reports of AIE occurring after surgery for appendiceal cancer. This report describes the diagnosis and treatment of a patient with an appendiceal cancer and postoperative AIE.

CASE SUMMARY

We report the case of a 47-year-old man who was transferred to our hospital due to a recurrent low intestinal obstruction. Abdominal enhanced computed tomography was used to consider the possibility of a terminal ileal tumor with serous infiltration and lymph node metastasis. A right hemi-colectomy was performed under general anesthesia with an ileo-transcolon anastomosis and laparoscopic exploration. The postoperative pathologic evaluation revealed a high-grade goblet cell carcinoma of the appendix, accompanied by mesangial and abdominal lymph node metastases, and neural tube and vascular infiltration. The operation was completed without complication. The patient developed restlessness on postoperative day 4, and gradually developed a disturbance of consciousness on postoperative day 6. He was transferred to West China Hospital of Sichuan University and diagnosed with AIE.

CONCLUSION

Albeit rare, the occurrence of neurologic and psychiatric symptoms in patients with an appendiceal cancer postoperatively suggests the possibility of AIE.

Keywords: Appendiceal cancer; Goblet cell carcinoma; Repeated ileus; Postoperative; Autoimmune encephalitis; Case report

Core Tip: Tumors (paraneoplastic) are one of the etiologies of autoimmune encephalitis (AIE). However, there are no reports of AIE occurring after surgery for appendiceal cancer. This report we describes a 47-year-old man who was transferred to our hospital due to a recurrent low intestinal obstruction and a right hemi-colectomy was performed with an ileo-transcolon anastomosis and laparoscopic exploration. But he developed a disturbance of consciousness on postoperative day 6, and diagnosed with AIE at last. We report this case in the hope of giving some guidance to clinicians with similar challenging cases.