CHEST Guidelines-A-58-Year-Old-Man-With-Episodic-Hypercapnic-Respir

A-58-Year-Old-Man-With-Episodic-Hypercapnic-Respir

Pdf Summary

A 58-year-old man presented with episodic hypercapnic respiratory failure, characterized by progressive symptoms of weight loss, weakness, dizziness, and notable episodes of loss of consciousness with absent respirations. During his hospital stay, the patient required intubation due to repeated paroxysmal apnea episodes, which were found to involve hypercapnia, necessitating invasive ventilatory support and intensive care admission.<br /><br />The patient had a history of castrate-resistant prostatic carcinoma with metastases, managed with various medications, including leuprolide. Findings from his physical and neurological examinations highlighted issues such as torsional nystagmus and weak gag reflex, but normal motor and sensory responses. Multiple diagnostic tests, including EEG and imaging, showed no structural abnormalities, but cerebrospinal fluid analysis indicated elevated anti-Hu antibodies, suggestive of paraneoplastic involvement.<br /><br />The diagnosis concluded as paraneoplastic anti-Hu brainstem encephalitis causing central hypoventilation syndrome, likely linked to his prostate cancer transitioning into a neuroendocrine-like response due to androgen deprivation therapy. Symptoms of this condition include dysregulation within the brainstem's respiratory centers, leading to dangerous apneic events.<br /><br />Management involved immunomodulatory therapy, like methylprednisolone, plasma exchange, and rituximab, leading to improvements in some symptoms, though the patient required tracheostomy and gastrostomy for persistent complications. Subsequent chemotherapy was initiated due to metastases.<br /><br />This case underlines the criticality of identifying paraneoplastic syndromes as potential causes of unexplained central hypoventilation in patients with malignancy backgrounds. Early recognition and treatment are vital to avoid extended invasive support and to guide further cancer evaluation and management.

Keywords

hypercapnic respiratory failure

paraneoplastic syndrome

anti-Hu antibodies

brainstem encephalitis

central hypoventilation

castrate-resistant prostate cancer

neuroendocrine response

immunomodulatory therapy

tracheostomy

metastases