Viral and paraneoplastic encephalitis in a patient with liver transplant with unilateral temporoparietal lobe abnormalities: a diagnostic challenge.

We report a patient who recently had a liver transplant presented with increasing confusion and intermittent hallucinations. MRI of the brain revealed diffuse left temporal and parietal lobe swelling with cortical diffusion restriction suggestive of possible infectious aetiology, although stroke was also possible given the presence of left posterior cerebral arteries with fetal origin in the anterior circulation. An EEG demonstrated subclinical seizures, for which he was placed on an antiepileptic medication. Routine laboratory testing, lumbar puncture, serum and cerebrospinal fluid testing for viral and paraneoplastic encephalitis, and brain biopsy were performed on our patient. Our clinical diagnosis was viral encephalitis, and positive N-type voltage-gated calcium channel antibody titres were suggestive of paraneoplastic limbic encephalitis. Treatment with antiviral and antiepileptic medications for subclinical seizures resulted in the improvement of his mental status, language output and motor functioning.