1
|
De León AM, Harrison TB, Garcia-Santibanez R. Update on Paraneoplastic Neuromuscular Disorders. Curr Treat Options Neurol 2022. [DOI: 10.1007/s11940-022-00722-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
2
|
A Case of Localized Prostate Cancer Associated with Polymyalgia Rheumatica with Marked Symptomatic Improvement after Robot-Assisted Radical Prostatectomy. Case Rep Urol 2021; 2021:8026883. [PMID: 34691800 PMCID: PMC8536426 DOI: 10.1155/2021/8026883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 09/21/2021] [Indexed: 11/18/2022] Open
Abstract
A 73-year-old man visited our hospital with chief complaints of fever of unknown origin and bilateral shoulder and hip joint pain. He was initially diagnosed with polymyalgia rheumatica (PMR). Although the patient was treated with prednisolone 15 mg/day, his PMR-related symptoms did not improve. Further examination was performed as the patient was suspected of having paraneoplastic syndrome. Assessment results showed prostate cancer without metastases. After undergoing robot-assisted radical prostatectomy, the patient's PMR-related symptoms dramatically improved. Hence, the prednisolone dose was decreased to 4 mg/day. PCa may have triggered the development of PMR through the activation of immune-mediated systemic inflammatory responses.
Collapse
|
3
|
Ketineni S, Kodali S, Gorantla S. A Rare Case of Sensory Neuropathy Associated with Transitional Cell Carcinoma of the Bladder. Case Rep Oncol 2021; 13:1397-1401. [PMID: 33442362 PMCID: PMC7772828 DOI: 10.1159/000510742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 08/03/2020] [Indexed: 02/01/2023] Open
Abstract
Malignancies can trigger an autoimmune response against the nervous system and manifest as paraneoplastic neurological syndromes (PNS). Initial symptoms of PNS may develop up to 5 years prior to the diagnosis of the underlying malignancy. We report a rare case of PNS associated with transitional cell carcinoma of the bladder in a 70-year-old male with a 6-month history of rapidly progressive symmetric sensory neuropathy. Peripheral neuropathy serological workup was unremarkable. A paraneoplastic neuropathy panel revealed anti-Hu autoantibodies. Further evaluation with a whole-body PET scan could not identify the primary malignancy, but it showed hypermetabolic hilar lymph nodes. An endobronchial ultrasound biopsy of the hilar lymph nodes was negative for cancer. The patient developed painless hematuria 2.5 years after the onset of the sensory neuropathy. Cystoscopy with biopsy revealed non-muscle-invasive transitional cell carcinoma of the bladder. Progression of the sensory neuropathy stopped after tumor resection. This case highlights the importance of a diligent and systematic approach to diagnose PNS. A relentless search is often required to detect PNS-associated occult malignancies.
Collapse
Affiliation(s)
- Sujitha Ketineni
- Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, Illinois, USA
| | - Sreenath Kodali
- Department of Hematology and Oncology, McFarland Clinic, Ames, Iowa, USA
| | - Sasikanth Gorantla
- Department of Neurology, University of Illinois College of Medicine at Peoria and OSF HealthCare Illinois Neurological Institute, Peoria, Illinois, USA
| |
Collapse
|
4
|
Blum TG, Misch D, Kollmeier J, Thiel S, Bauer TT. Autoimmune disorders and paraneoplastic syndromes in thymoma. J Thorac Dis 2020; 12:7571-7590. [PMID: 33447448 PMCID: PMC7797875 DOI: 10.21037/jtd-2019-thym-10] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Thymomas are counted among the rare tumour entities which are associated with autoimmune disorders (AIDs) and paraneoplastic syndromes (PNS) far more often than other malignancies. Through its complex immunological function in the context of the selection and maturation of T cells, the thymus is at the same time highly susceptible to disruptive factors caused by the development and growth of thymic tumours. These T cells, which are thought to develop to competent immune cells in the thymus, can instead adopt autoreactive behaviour due to the uncontrolled interplay of thymomas and become the trigger for AID or PNS affecting numerous organs and tissues within the human body. While myasthenia gravis is the most prevalent PNS in thymoma, numerous others have been described, be they related to neurological, cardiovascular, gastrointestinal, haematological, dermatological, endocrine or systemic disorders. This review article sheds light on the pathophysiology, epidemiology, specific clinical features and therapeutic options of the various forms as well as courses and outcomes of AID/PNS in association with thymomas. Whenever suitable and backed by the limited available evidence, the perspectives from both the thymoma and the affected organ/tissue will be highlighted. Specific issues addressed are the prognostic significance of thymectomy on myasthenia gravis and other thymoma-associated AID/PND and further the impact and safety of immunotherapies on AID and PND relating to thymomas.
Collapse
Affiliation(s)
- Torsten Gerriet Blum
- Department of Pneumology, Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin, Germany
| | - Daniel Misch
- Department of Pneumology, Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin, Germany
| | - Jens Kollmeier
- Department of Pneumology, Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin, Germany
| | - Sebastian Thiel
- Department of Pneumology, Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin, Germany
| | - Torsten T Bauer
- Department of Pneumology, Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin, Germany
| |
Collapse
|
5
|
Abstract
Background: Movement disorders are often a prominent part of the phenotype of many neurologic rare diseases. In order to promote awareness and diagnosis of these rare diseases, the International Parkinson’s and Movement Disorders Society Rare Movement Disorders Study Group provides updates on rare movement disorders. Methods: In this narrative review, we discuss the differential diagnosis of the rare disorders that can cause chorea. Results: Although the most common causes of chorea are hereditary, it is critical to identify acquired or symptomatic choreas since these are potentially treatable conditions. Disorders of metabolism and mitochondrial cytopathies can also be associated with chorea. Discussion: The present review discusses clues to the diagnosis of chorea of various etiologies. Authors propose algorithms to help the clinician in the diagnosis of these rare disorders.
Collapse
|
6
|
Budhram A, Leung A, Nicolle MW, Burneo JG. Diagnosing autoimmune limbic encephalitis. CMAJ 2020; 191:E529-E534. [PMID: 31085562 DOI: 10.1503/cmaj.181548] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Adrian Budhram
- Departments of Clinical Neurological Sciences (Budhram, Nicolle, Burneo), and Medical Imaging (Leung), and the Neuroepidemiology Research Unit (Burneo), Western University, London, Ont.
| | - Andrew Leung
- Departments of Clinical Neurological Sciences (Budhram, Nicolle, Burneo), and Medical Imaging (Leung), and the Neuroepidemiology Research Unit (Burneo), Western University, London, Ont
| | - Michael W Nicolle
- Departments of Clinical Neurological Sciences (Budhram, Nicolle, Burneo), and Medical Imaging (Leung), and the Neuroepidemiology Research Unit (Burneo), Western University, London, Ont
| | - Jorge G Burneo
- Departments of Clinical Neurological Sciences (Budhram, Nicolle, Burneo), and Medical Imaging (Leung), and the Neuroepidemiology Research Unit (Burneo), Western University, London, Ont
| |
Collapse
|
7
|
[Autoimmune reactions and paraneoplastic syndromes]. Radiologe 2019; 58:1080-1090. [PMID: 30238288 DOI: 10.1007/s00117-018-0453-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
CLINICAL ISSUE Autoimmune disorders of the central nervous system (CNS) are common but are also a heterogeneous group of diseases. The most common form is multiple sclerosis (MS), others are clinically isolated syndrome (CIS), acute demyelinating encephalomyelitis (ADEM) and neuromyelitis optica spectrum disorders (NMOSD). Paraneoplastic syndromes are rare and tumor-associated, they are not induced by direct invasion of tumor tissue but by tumor-associated autoantibodies mostly against specific CNS proteins, e. g. limbic encephalitis and paraneoplastic cerebellar ataxia or degeneration. DIAGNOSTICS, STANDARD RADIOLOGICAL METHODS, PERFORMANCE AND ACHIEVEMENTS: The correct diagnosis of autoimmune and paraneoplastic syndromes can still be challenging. In addition to the patient history, clinical examination and blood as well as cerebrospinal fluid (CSF) tests, magnetic resonance imaging (MRI) is gaining importance in the diagnostics. It is important not only in primary diagnostics but also in follow-up and therapy monitoring, especially in MS with specific therapies to detect therapy complications, such as progressive multifocal leukoencephalopathy as early as possible. In paraneoplastic syndromes MRI can also be an important component in the diagnostics but can also initially be negative and typical signal changes become visible only in follow-up scans. PRACTICAL RECOMMENDATIONS In paraneoplastic syndromes the correct diagnosis is based on laboratory tests for specific autoantibodies in serum and CSF. TREATMENT The treatment of autoimmune and paraneoplastic disorders of the CNS ranges from steroids and immunosuppressive agents to plasmapheresis, depending on the specific disorder.
Collapse
|
8
|
Mirallas O, Rial N, Martín-Cullell B, Recio-Iglesias J. A rare case of long-term paraesthesia diagnosed as a paraneoplastic syndrome by anti-SOX1 antibody determination. BMJ Case Rep 2019; 12:12/7/e228916. [PMID: 31315840 DOI: 10.1136/bcr-2018-228916] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Paraneoplastic syndromes (PS) are a rare presentation of cancer, most commonly associated with small cell lung cancer (SCLC), breast cancer and haematologic malignancies. The diagnosis of PS is challenging because it could affect multiple organ systems and it may present before the tumour is visible by imaging. We report a malignant tumour diagnosed in a male patient who referred long-term paraesthesia and proximal muscle strength loss. After ruling out common causes of polyneuropathy, the anti-SOX1 antibody gave light to the diagnosis. A pulmonary opacity in the upper right lobe was observed in the chest X-ray and a pulmonary tumour was later confirmed by CT scan. The biopsy of the cervical lymphadenopathy determined an SCLC, which caused a PS called Lambert-Eaton myasthenic syndrome (LEMS). Our case raises awareness of a rare PS presentation, which can be diagnosed by specific antibodies, allowing early diagnosis and treatment of lung cancer.
Collapse
Affiliation(s)
- Oriol Mirallas
- Internal Medicine Department, Hospital Vall d'Hebron, Barcelona, Spain
| | - Nuria Rial
- Internal Medicine Department, Hospital Vall d'Hebron, Barcelona, Spain
| | - Berta Martín-Cullell
- Medical Oncology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | |
Collapse
|
9
|
Souza SM, Santos BO, Sodré ICA, Oliveira ALP, Terrana D, Spitz M. Paraneoplastic cerebellar degeneration as initial presentation of renal cell carcinoma. CEREBELLUM & ATAXIAS 2019; 6:8. [PMID: 31333854 PMCID: PMC6617947 DOI: 10.1186/s40673-019-0102-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 06/25/2019] [Indexed: 11/17/2022]
Abstract
Background Paraneoplastic cerebellar degeneration is usually associated with gynecological and breast cancer, lung cancer, and Hodgkin’s lymphoma. Renal cell carcinoma has rarely been described as an underlying malignancy in these cases. Case presentation We report the case of a 75 year-old woman who develop cerebellar ataxia following a respiratory viral infection. During investigation, around 1 year afterward, she noticed constitutional symptoms suggestive of malignancy. Renal carcinoma was found and the hypothesis of paraneoplastic cerebellar degeneration was considered. Conclusions As no specific antineuronal antibodies have been described in the setting of renal cell carcinoma, paraneoplastic cerebellar degeneration should be considered when the tumor is detected and other causes are excluded. Immunotherapy should be prescribed as soon as possible.
Collapse
Affiliation(s)
- Sara M Souza
- Neurology Service, Pedro Ernesto University Hospital, State University of Rio de Janeiro, Blv 28 de setembro, 77 - Vila Isabel, Rio de Janeiro, 20551-030 Brazil
| | - Barbara O Santos
- Neurology Service, Pedro Ernesto University Hospital, State University of Rio de Janeiro, Blv 28 de setembro, 77 - Vila Isabel, Rio de Janeiro, 20551-030 Brazil
| | - Isadora C A Sodré
- Neurology Service, Pedro Ernesto University Hospital, State University of Rio de Janeiro, Blv 28 de setembro, 77 - Vila Isabel, Rio de Janeiro, 20551-030 Brazil
| | - Ana Luiza P Oliveira
- Neurology Service, Pedro Ernesto University Hospital, State University of Rio de Janeiro, Blv 28 de setembro, 77 - Vila Isabel, Rio de Janeiro, 20551-030 Brazil
| | - Diogo Terrana
- Neurology Service, Pedro Ernesto University Hospital, State University of Rio de Janeiro, Blv 28 de setembro, 77 - Vila Isabel, Rio de Janeiro, 20551-030 Brazil
| | - Mariana Spitz
- Neurology Service, Pedro Ernesto University Hospital, State University of Rio de Janeiro, Blv 28 de setembro, 77 - Vila Isabel, Rio de Janeiro, 20551-030 Brazil
| |
Collapse
|
10
|
Larkin J, Chmielowski B, Lao CD, Hodi FS, Sharfman W, Weber J, Suijkerbuijk KPM, Azevedo S, Li H, Reshef D, Avila A, Reardon DA. Neurologic Serious Adverse Events Associated with Nivolumab Plus Ipilimumab or Nivolumab Alone in Advanced Melanoma, Including a Case Series of Encephalitis. Oncologist 2017; 22:709-718. [PMID: 28495807 DOI: 10.1634/theoncologist.2016-0487] [Citation(s) in RCA: 190] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 02/02/2017] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Despite unprecedented efficacy across multiple tumor types, immune checkpoint inhibitor therapy is associated with a unique and wide spectrum of immune-related adverse events (irAEs), including neurologic events ranging from mild headache to potentially life-threatening encephalitis. Here, we summarize neurologic irAEs associated with nivolumab and ipilimumab melanoma treatment, present cases of treatment-related encephalitis, and provide practical guidance on diagnosis and management. METHODS We searched a Global Pharmacovigilance and Epidemiology database for neurologic irAEs reported over an 8-year period in patients with advanced melanoma receiving nivolumab with or without ipilimumab from 12 studies sponsored by Bristol-Myers Squibb. Serious neurologic irAEs were reviewed, and relationship to nivolumab or ipilimumab was assigned. RESULTS In our search of 3,763 patients, 35 patients (0.93%) presented with 43 serious neurologic irAEs, including neuropathy (n = 22), noninfective meningitis (n = 5), encephalitis (n = 6), neuromuscular disorders (n = 3), and nonspecific adverse events (n = 7). Study drug was discontinued (n = 20), interrupted (n = 8), or unchanged (n = 7). Most neurologic irAEs resolved (26/35 patients; 75%). Overall, median time to onset was 45 days (range 1-170) and to resolution was 32 days (2-809+). Median time to onset of encephalitis was 55.5 days (range 18-297); four cases resolved and one was fatal. CONCLUSION Both oncologists and neurologists need to be aware of signs and symptoms of serious but uncommon neurologic irAEs associated with checkpoint inhibitors. Prompt diagnosis and management using an established algorithm are critical to minimize serious complications from these neurologic irAEs. IMPLICATIONS FOR PRACTICE With increasing use of checkpoint inhibitors in cancer, practicing oncologists need to be aware of the potential risk of neurologic immune-related adverse events and be able to provide prompt treatment of this uncommon, but potentially serious, class of adverse events. We summarize neurologic adverse events related to nivolumab alone or in combination with ipilimumab in patients with advanced melanoma from 12 studies and examine in depth 6 cases of encephalitis. We also provide input and guidance on the existing neurologic adverse events management algorithm for nivolumab and ipilimumab.
Collapse
Affiliation(s)
| | - Bartosz Chmielowski
- University of California Los Angeles Medical Center, Santa Monica, California, USA
| | | | - F Stephen Hodi
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - William Sharfman
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, Maryland, USA
| | - Jeffrey Weber
- New York University Langone Medical Center, New York, New York, USA
| | | | | | - Hewei Li
- Bristol-Myers Squibb, Princeton, New Jersey, USA
| | | | | | | |
Collapse
|
11
|
Nabil A, Houyam T, Adil B, Jawad O, Ahmed B. Severe Paraneoplastic Parkinsonism: A Rare Cause Revealing Breast Cancer. J Clin Neurol 2017; 13:310-311. [PMID: 28748681 PMCID: PMC5532334 DOI: 10.3988/jcn.2017.13.3.310] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 03/06/2017] [Accepted: 03/09/2017] [Indexed: 12/20/2022] Open
Affiliation(s)
- Abida Nabil
- Department of Neurology, Hôpital Militaire d'instruction Mohamed V, Mohamed V-Souissi University, Rabat, Morocco
| | - Tibar Houyam
- Research Team in Neurology and Neurogenetics, Faculty of Medicine and Pharmacy, University Mohammed V, Rabat, Morocco.,Neurology B and Neurogenetics Department, Hôpital des Spécialités ONO, CHU Ibn Sina, Rabat, Morocco.
| | - Boudhas Adil
- Pathology Unit, Hôpital Militaire d'instruction Mohamed V, Mohamed V-Souissi University, Rabat, Morocco
| | - Oumerzouk Jawad
- Department of Neurology, Hôpital Militaire d'instruction Mohamed V, Mohamed V-Souissi University, Rabat, Morocco
| | - Bourazza Ahmed
- Department of Neurology, Hôpital Militaire d'instruction Mohamed V, Mohamed V-Souissi University, Rabat, Morocco
| |
Collapse
|
12
|
Gupta HV, Gervais C, Ross MA, Mehta SH. Purkinje Cell Cytoplasmic Antibody (PCA-2)-related Chorea-Dystonia Syndrome. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2016; 6:420. [PMID: 27708984 PMCID: PMC5039950 DOI: 10.7916/d8sx6dfj] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 08/29/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Harsh V Gupta
- Department of Neurology, Mayo Clinic, Scottsdale, AZ, USA
| | | | - Mark A Ross
- Department of Neurology, Mayo Clinic, Scottsdale, AZ, USA
| | | |
Collapse
|