Medical Mystery

In June 2011, 23-year-old Lauren Cantalope, an X-ray technician in Hastings, Pa., began suffering from terrible headaches. It was the start of a medical mystery that would land her in a coma — and near death — until the tangled threads of her symptoms were unraveled by Pittsburgh neurologist Neil Busis. 

 Lauren’s headaches were soon accompanied by a high fever, facial numbness and severe nausea. “At first, my doctor thought it could be migraines or a stomach bug,” she recalls, “but I kept getting worse.” She had tests done at an Altoona hospital, but the results only muddied the waters, revealing that it might be meningitis or encephalitis.

 A spinal tap showed inflammation and unusual cells, suggesting meningitis again — or even leukemia. By this point, Lauren had sunk into a state of severe fatigue and confusion. She was transferred to the Hillman Cancer Center, a division of UPMC Presbyterian Shadyside Hospital, for what doctors thought would be a cancer diagnosis. Dr. Busis, the hospital’s chief of neurology, was asked to consult on her case. “I didn’t think it was cancer,” he says. Instead, he suspected a benign ovarian tumor, called a teratoma, which he noticed on her CT scan might be the cause of her symptoms, albeit in a very unexpected way. 

Meanwhile, Lauren’s condition became critical. “Within two days of arriving, she was comatose, on a ventilator and seizing,” says Dr. Busis. “Highly unusual for a healthy young woman.” As he was pondering the mystery of Lauren’s condition, Dr. Busis remembered a neurology lecture he’d attended a year earlier. “A light bulb went off,” he says. The speaker had briefly mentioned the very rare paraneoplastic syndrome, in which young women with tumors like Lauren’s suffered from brain disease when the tumors triggered the body’s autoimmune response.

 Although only 150 cases of the disease had ever been documented, Dr. Busis realized that Lauren’s symptoms were almost identical. “The immune system fights off the tumor threat with antibodies,” he explains. “[The] problem is [that] the antibodies cross-react with normal brain tissue and make the brain sick.” Curing the syndrome called for tumor removal and treatment of the immune system. “So I called an obstetrician/gynecologist here at the hospital,” Dr. Busis says, “and told him, ‘I think the teratoma is the problem. I’d like you to take it out; it might save her life.’” 

The simple operation went off without a hitch. Post-surgery treatment of Lauren’s immune system included intravenous immunoglobin to block bad antibodies and steroids. Lauren’s symptoms abated; Dr. Busis had made the right call. While she had only been in a coma for 24 hours, she did not wake up for 3 weeks after the surgery. Only then did she began to learn about all she’d been through and about the doctor who had saved her life. “Honestly, everything from that July to September is a blur to me,” she admits. “I don’t remember much about Altoona or Shadyside … or meeting Dr. Busis. But my family told me how great he was, along with everyone else at the hospital.” It took Lauren a long time to feel truly better, but given her grave illness, Dr. Busis calls it “a remarkable recovery;” she spent a month in the hospital and several more months in physical, speech and occupational therapy in Altoona. Today, she’s home in Hastings, working again and also engaged. She says “things are finally normal again.”