1
|
Cherifi F, Dereeper O, Forestier A, Joly F, Penel N. Paraneoplastic Demyelinating Inflammatory Neuropathy Revealing Metastatic Seminoma: A Case Report. Chemotherapy 2022; 67:256-260. [PMID: 35700701 DOI: 10.1159/000525154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 05/13/2022] [Indexed: 11/19/2022]
Abstract
Paraneoplastic neurological syndrome (PNS) is uncommon and not well known. PNS can reveal cancer, but its role in seminomas has not been described explicitly. We report the case of a 36-year-old man with unremarkable medical history and no comorbidities who was diagnosed with a retroperitoneal metastatic seminoma. The patient's general condition deteriorated, and he developed progressive neurological palsy without other clinical anomalies. Electromyography revealed demyelinating, non-lengthy neuropathy. Guillain-Barré syndrome was initially suspected. However, a positron emission tomography scan revealed a retroperitoneal mass, and blood markers revealed increased human chorionic gonadotropin. The patient was diagnosed with PNS, and a computed tomography-guided biopsy revealed a metastatic seminoma without a primary tumor. No circulating neural antibodies were detected. Human polyvalent immunoglobulin was simultaneously administered with chemotherapy. After three cycles of a cisplatin-etoposide-bleomycin, a complete biological and metabolic response rate was observed, and his neurological symptoms rapidly improved. Four years later, the patient responded completely, without any neurological complaints. Paraneoplastic demyelinating inflammatory neuropathy can lead to advanced seminoma diagnosis. Prompt management of seminomas with cisplatin-based regimens provides the best chance of cure for both advanced seminoma and paraneoplastic syndrome.
Collapse
Affiliation(s)
- François Cherifi
- Caen Normandie University, Medical School, Caen, France.,Medical Oncology Department, Centre François Baclesse, Caen, France
| | - Olivier Dereeper
- Neurology Department, Hospital Center Dr. Jean Eric TECHER, Calais, France
| | | | - Florence Joly
- Caen Normandie University, Medical School, Caen, France.,Medical Oncology Department, Centre François Baclesse, Caen, France
| | - Nicolas Penel
- Medical Oncology Department, Centre Oscar Lambret, Lille, France
| |
Collapse
|
2
|
Guillain-Barré Syndrome-Like Polyneuropathy Associated with Immune Checkpoint Inhibitors: A Systematic Review of 33 Cases. BIOMED RESEARCH INTERNATIONAL 2021; 2021:9800488. [PMID: 34458371 PMCID: PMC8390151 DOI: 10.1155/2021/9800488] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 06/08/2021] [Accepted: 08/05/2021] [Indexed: 01/10/2023]
Abstract
Immune checkpoint inhibitors (ICIs) have been increasingly used in the treatment of various types of tumors with favorable results. But these treatments also led to a variety of immune-related adverse events (irAEs). Neurological irAEs such as Guillain-Barré Syndrome are rare and may have serious consequences once they occur. A systematic literature search was performed in PubMed and Embase for all case reports of GBS associated with ICIs published in English reporting on human beings from 1990 up to date. A total of 30 case reports (total patients = 33) were used for final analysis. The included cases were from 11 countries, covering 10 tumor types, with melanoma accounting for the largest number. The mean age was 62.2 ± 11.1 years old, and males were dominant (male: 26 and female: 7). The median time of initial symptoms was 8.2 weeks after the 1st dose of ICIs. The most common manifestations of GBS associated with ICIs were weakness, hyporeflexia or areflexia, and paresthesia in order. The GBS subtypes suggested by electrophysiological results were acute inflammatory demyelinating polyneuropathy (AIDP), acute motor axonal neuropathy (AMAN), and Miller Fisher syndrome (MFS). The protein level of CSF in patients with GBS related to ICIs was 180.68 ± 152.51 mg/dl. Immediate termination of ICIs followed by intravenous immunoglobulin was the preferred treatment option. 72.7% of patients recovered or had residual mild dysfunction after treatment. Elderly male patients with melanoma were most likely to develop ICI-related GBS. The specific neurological symptoms, CSF analysis, and electrophysiological examination were important means of diagnosis.
Collapse
|
3
|
Abstract
Autoimmune neurogenic dysphagia refers to manifestation of dysphagia due to autoimmune diseases affecting muscle, neuromuscular junction, nerves, roots, brainstem, or cortex. Dysphagia is either part of the evolving clinical symptomatology of an underlying neurological autoimmunity or occurs as a sole manifestation, acutely or insidiously. This opinion article reviews the autoimmune neurological causes of dysphagia, highlights clinical clues and laboratory testing that facilitate early diagnosis, especially when dysphagia is the presenting symptom, and outlines the most effective immunotherapeutic approaches. Dysphagia is common in inflammatory myopathies, most prominently in inclusion body myositis, and is frequent in myasthenia gravis, occurring early in bulbar-onset disease or during the course of progressive, generalized disease. Acute-onset dysphagia is often seen in Guillain–Barre syndrome variants and slowly progressive dysphagia in paraneoplastic neuropathies highlighted by the presence of specific autoantibodies. The most common causes of CNS autoimmune dysphagia are demyelinating and inflammatory lesions in the brainstem, occurring in patients with multiple sclerosis and neuromyelitis optica spectrum disorders. Less common, but often overlooked, is dysphagia in stiff-person syndrome especially in conjunction with cerebellar ataxia and high anti-GAD autoantibodies, and in gastrointestinal dysmotility syndromes associated with autoantibodies against the ganglionic acetyl-choline receptor. In the setting of many neurological autoimmunities, acute-onset or progressive dysphagia is a potentially treatable condition, requiring increased awareness for prompt diagnosis and early immunotherapy initiation.
Collapse
|
4
|
Golden EP, Vernino S. Autoimmune autonomic neuropathies and ganglionopathies: epidemiology, pathophysiology, and therapeutic advances. Clin Auton Res 2019; 29:277-288. [DOI: 10.1007/s10286-019-00611-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 05/03/2019] [Indexed: 12/12/2022]
|
5
|
Siles AM, Martínez‐Hernández E, Araque J, Diaz‐Manera J, Rojas‐Garcia R, Gallardo E, Illa I, Graus F, Querol L. Antibodies against cell adhesion molecules and neural structures in paraneoplastic neuropathies. Ann Clin Transl Neurol 2018; 5:559-569. [PMID: 29761119 PMCID: PMC5945957 DOI: 10.1002/acn3.554] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 02/21/2018] [Accepted: 02/22/2018] [Indexed: 12/16/2022] Open
Abstract
Objective Paraneoplastic neurological syndromes (PNS) are rare neurological disorders in which ectopic expression of neural antigens by a tumor results in an autoimmune attack against the nervous system. Onconeural antibodies not only guide PNS diagnosis but may also help detecting underlying malignancies. Our project aims to uncover new potential antibodies in paraneoplastic neuropathies (PN). Methods Thirty‐four patients fulfilling diagnostic criteria of possible (n = 9; 26.5%) and definite (n = 25; 73.5%) PN without onconeural antibodies and 28 healthy controls were included in our study. Sera were tested for known antibodies against neural cell adhesion molecules and screened for novel IgG and IgM reactivities against nerve components: dorsal root ganglia (DRG) neurons, motor neurons, and Schwann cells. Patients showing autoantibodies against any of these cell types were used for immunoprecipitation (IP) studies. Results Overall, 9 (26.5%) patients showed significant reactivity against DRG neurons, motor neurons, or Schwann cells, whereas 5 (17.9%) healthy controls only showed moderate reactivity. Compared with control sera, serum samples from patients with paraneoplastic sensory‐motor neuropathies had a higher frequency of IgM antibodies against Schwann cells (0% vs. 40%; P = 0.0028). No novel antigens were identified from our IP experiments. Antibodies against the neural adhesion molecules CNTN1, NF155, NF140, NF186, NCAM1, L1CAM, and the CNTN1/CASPR1 complex were not detected in patients with PN. One (2.9%) patient with CIDP and thymoma had CASPR2 antibodies. Interpretation Almost 30% of patients with PN harbor antibodies targeting neural structures, suggesting that novel neoplasm‐associated antigens remain to be discovered.
Collapse
Affiliation(s)
- Ana M. Siles
- Neuromuscular Diseases UnitNeurology DepartmentHospital de la Santa Creu i Sant PauUniversitat Autònoma de BarcelonaBarcelonaSpain
- Centro para la Investigación Biomédica en Red en Enfermedades Raras (CIBERER)MadridSpain
| | - Eugenia Martínez‐Hernández
- Centro para la Investigación Biomédica en Red en Enfermedades Raras (CIBERER)MadridSpain
- Service of Neurology and NeuroimmunologyAugust Pi Sunyer Biomedical Research Institute (IDIBAPS)Hospital ClínicUniversity of BarcelonaSpain
| | - Josefa Araque
- Neuromuscular Diseases UnitNeurology DepartmentHospital de la Santa Creu i Sant PauUniversitat Autònoma de BarcelonaBarcelonaSpain
- Centro para la Investigación Biomédica en Red en Enfermedades Raras (CIBERER)MadridSpain
| | - Jordi Diaz‐Manera
- Neuromuscular Diseases UnitNeurology DepartmentHospital de la Santa Creu i Sant PauUniversitat Autònoma de BarcelonaBarcelonaSpain
- Centro para la Investigación Biomédica en Red en Enfermedades Raras (CIBERER)MadridSpain
| | - Ricard Rojas‐Garcia
- Neuromuscular Diseases UnitNeurology DepartmentHospital de la Santa Creu i Sant PauUniversitat Autònoma de BarcelonaBarcelonaSpain
- Centro para la Investigación Biomédica en Red en Enfermedades Raras (CIBERER)MadridSpain
| | - Eduard Gallardo
- Neuromuscular Diseases UnitNeurology DepartmentHospital de la Santa Creu i Sant PauUniversitat Autònoma de BarcelonaBarcelonaSpain
- Centro para la Investigación Biomédica en Red en Enfermedades Raras (CIBERER)MadridSpain
| | - Isabel Illa
- Neuromuscular Diseases UnitNeurology DepartmentHospital de la Santa Creu i Sant PauUniversitat Autònoma de BarcelonaBarcelonaSpain
- Centro para la Investigación Biomédica en Red en Enfermedades Raras (CIBERER)MadridSpain
| | - Francesc Graus
- Service of Neurology and NeuroimmunologyAugust Pi Sunyer Biomedical Research Institute (IDIBAPS)Hospital ClínicUniversity of BarcelonaSpain
| | - Luis Querol
- Neuromuscular Diseases UnitNeurology DepartmentHospital de la Santa Creu i Sant PauUniversitat Autònoma de BarcelonaBarcelonaSpain
- Centro para la Investigación Biomédica en Red en Enfermedades Raras (CIBERER)MadridSpain
| |
Collapse
|
6
|
Abstract
Autoimmune movement disorders are caused by an aberrant immune response to neural self-antigens. These disorders may be paraneoplastic, parainfectious, or (most commonly) idiopathic. The neurological presentations are diverse, and sometimes multifocal. Movement disorders can occur as part of the spectrum with phenotypes including chorea, myoclonus, ataxia, CNS hyperexcitability (including stiff-person syndrome), dystonia, and parkinsonism. Symptoms are subacute in onset and may have a fluctuating course. The best characterized disorders are unified by neural autoantibodies identified in serum or cerebrospinal fluid. The antibody specificity may predict the association with cancer and the response to immunotherapy. In this article, we review autoimmune-mediated movement disorders, associated cancers, diagnosis, and treatment.
Collapse
|
7
|
Yang I, Jaros J, Bega D. Paraneoplastic Peripheral Nervous System Manifestations of Renal Cell Carcinoma: A Case Report and Review of the Literature. Case Rep Neurol 2017; 9:22-30. [PMID: 28413402 PMCID: PMC5346938 DOI: 10.1159/000458435] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 01/30/2017] [Indexed: 11/19/2022] Open
Abstract
Neurologic symptoms secondary to a paraneoplastic syndrome may be the presenting manifestation of a previously undiagnosed cancer, and alertness to these syndromes may provide an opportunity for early detection and treatment of a cancer. Paraneoplastic weakness is a rare manifestation of renal cell carcinoma and may present with variable electrophysiological features. We present a case of a patient with progressive weakness, sensory changes, and urinary retention, with electrophysiological features suggestive of a complex peripheral nervous system syndrome. Ultimately, a renal cell mass was detected and resected, resulting in significant clinical improvement. We review the literature, cataloging the known neurologic syndromes and antibodies associated with renal cell carcinoma. This case highlights that paraneoplastic neurological disorders associated with RCC can take on many features and provides a resource to practitioners for early detection of a neurologic paraneoplastic syndrome arising from renal cell carcinoma.
Collapse
Affiliation(s)
- Ingrid Yang
- Rehabilitation Institute of Chicago, Northwestern Feinberg University School of Medicine, Chicago, IL, USA
| | - Joanna Jaros
- University of Illinois College of Medicine, Chicago, IL, USA
| | - Danny Bega
- Northwestern Feinberg University School of Medicine, Chicago, IL, USA
| |
Collapse
|
8
|
Waheed W, Boyd J, Khan F, Mount SL, Borden NM, Tandan R. Double trouble: para-neoplastic anti-PCA-2 and CRMP-5-mediated small fibre neuropathy followed by chorea associated with small cell lung cancer and evolving radiological features. BMJ Case Rep 2016; 2016:bcr-2016-215158. [PMID: 27571910 DOI: 10.1136/bcr-2016-215158] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Patients with Purkinje cell cytoplasmic autoantibody type 2 (PCA-2) and collapsin response-mediator protein-5 (CRMP-5) autoantibody can present with multifocal elements of encephalomyeloneuropathy. Except for an anecdotal report, case descriptions of paraneoplastic small fibre neuropathy are lacking. We report paraneoplastic small fibre neuropathy followed by chorea associated with small cell lung cancer. A man aged 57 years with a 35 pack-year smoking history presented with painless subacute paresthesia and weight fluctuation. A non-length-dependent small fibre neuropathy was confirmed by skin biopsy. Further testing revealed positive serum PCA-2 and CRMP-5 autoantibodies, which after positron emission tomography-CT led to histological confirmation of a small cell lung cancer. Initially, abnormal MRI and cerebrospinal fluid studies suggested central nervous system (CNS) involvement which was subclinical; however, 6 months later during antitumour therapy, the patient became symptomatic with choreoathetosis. After combined chemoradiation as well as immunosuppressive and symptomatic therapies, the clinical course stabilised, although residual neurological deficits remained at follow-up a year later. Coexistent PCA-2 and CRMP-5 autoantibodies may occur in the setting of small fibre peripheral neuropathy and choreoathetosis and predict cancer type. Two paraneoplastic syndromes can present successively over months; subclinical CNS involvement with evolving basal ganglia abnormalities can be a paraneoplastic manifestation. In the appropriate clinical setting, paraneoplastic testing should be considered in patients presenting with small fibre neuropathy.
Collapse
Affiliation(s)
- Waqar Waheed
- Department of Neurological Sciences, University of Vermont, Burlington, Vermont, USA
| | - James Boyd
- Department of Neurological Sciences, University of Vermont, Burlington, Vermont, USA
| | - Farrah Khan
- Internal Medicine (Division of Hematology-Oncology), University of Vermont College of Medicine, Burlington, Vermont, USA
| | - Sharon L Mount
- Division of Pathology, University of Vermont College of Medicine, Burlington, Vermont, USA
| | - Neil M Borden
- Radiology (Division of Neuroradiology), University of Vermont, Burlington, Vermont, USA
| | - Rup Tandan
- Department of Neurological Sciences, University of Vermont, Burlington, Vermont, USA
| |
Collapse
|
9
|
Abstract
Autoimmune disorders are increasingly recognized causes of several neurological disorders leading to significant clinical disability. This article reviews recent developments in our understanding on the pathophysiology, clinical presentations, and diagnoses of selected immune-mediated neurological disorders. It also provides a brief summary of current theories on autoimmunity and the role that certain environmental factors play in the development of immune-mediated neurological disorders. Recently recognized biomarkers might play a pathogenetic role or simply serve as a diagnostic tool.
Collapse
|