Acute Hemichorea in an Elderly Patient With Positive Anti-centromere Antibodies and Lung Tumor

TL;DR

An elderly woman with acute chorea and anti-centromere antibodies showed improvement with tiapride, despite a lung tumor, suggesting autoimmune mechanisms.

Contribution

This case highlights tiapride's effectiveness for autoimmune-related chorea in elderly patients without requiring immunotherapy or anti-tumor treatment.

Findings

The patient's chorea improved with low-dose tiapride alone.

A lung nodule was detected, but no anti-tumor therapy was needed.

Autoimmune mechanisms were suspected despite negative paraneoplastic antibody results.

Abstract

Though rare, autoimmune paraneoplastic and non-paraneoplastic chorea can be leading causes of adult-onset acute/subacute chorea. Here, we report a case of acute-onset chorea with suspected autoimmune-mediated mechanisms in a 79-year-old female who exhibited acute-onset choreiform movements on the right side of her body. She tested positive for anti-centromere antibodies (ACAs) without displaying symptoms of scleroderma. Blood sugar levels, genetic testing for Huntington’s disease, and an antibody panel related to paraneoplastic neurological syndrome were unremarkable. Brain magnetic resonance imaging revealed no significant abnormalities. Computed tomography (CT) identified an irregularly shaped nodule in the middle lobe of the right lung. An 18F-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET)-CT scan showed an accumulation of radioactivity in the nodule and slight hypermetabolism in the striatum of both hemispheres. Her choreiform movements almost disappeared with a low dose of tiapride alone, without the need for anti-tumor therapy or immunotherapy. In cases of adult-onset acute/subacute chorea, investigating neoplasms and autoimmune diseases as underlying conditions is recommended. Tiapride, due to its good tolerability, is a valuable symptomatic therapy for elderly patients presenting with chorea, even in cases driven by autoimmune mechanisms.

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