case_images: PMC11835123_01
case_images: No epileptiform discharges were found in 24-h video electroencephalogram (EEG) in this patient. We arranged 2 dynamic EEG tests within 3 days to detect EEG waves, but none of them detected any epileptic waves. Figure 1 shows one of the fragments.
case_images: medi-104-e41534-g001.jpg
case_images: PMC11835123_01_medi-104-e41534-g001.jpg
case_images: F1
case_images: During hospitalization, no epileptiform discharges were identified on a 24-hour video electroencephalogram (Fig. 1).
case_images: Cranial magnetic resonance imaging (MRI) showed mild atrophy in temporal lobe, cerebellar, and limbic area. T1 sequence (A and B), DWI sequence (C), and T2 FLAIR sequence (D).
case_images: medi-104-e41534-g002.jpg
case_images: PMC11835123_01_medi-104-e41534-g002.jpg
case_images: F2
case_images: Cranial magnetic resonance imaging revealed mild limbic system atrophy (Fig. 2).
case_images: Positive reaction with transfected HEK293 cells expressing DPPX after incubation with the patient's serum (A) (titer 1:10, CBA) and anti-DPPX negative control (B). CBA = cell-based assay, DPPX = dipeptidyl-peptidase-like protein-6.
case_images: medi-104-e41534-g003.jpg
case_images: PMC11835123_01_medi-104-e41534-g003.jpg
case_images: F3
case_images: A series of antibodies and viruses were screened using a cell-based assay, which revealed that the antibody against DPPX was present (titer of 1:10) in the serum (Fig. 3).
case_images: Gastroscopy pathology suggests lower esophageal adenocarcinoma (A and B).
case_images: medi-104-e41534-g004.jpg
case_images: PMC11835123_01_medi-104-e41534-g004.jpg
case_images: F4
case_images: Two years after discharge, telephone follow-up revealed that the patient had a gastric malignancy (Fig. 4) with multiple metastases, diagnosed in May 2023, and was being treated with palliative care.