Lung Carcinoma with Anti-Hu Paraneoplastic Syndrome
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《新英格兰医药杂志》
A 54-year-old female smoker presented with a three-month history of anorexia, fatigue, weight loss, dizziness, and a burning sensation in her hands and feet. She had marked postural hypotension. Her pupils were irregular, asymmetric (Panels A and B), and unresponsive to light and accommodation. Nerve-conduction studies confirmed a mononeuritis multiplex. Computed tomography of the thorax showed an irregular centimeter-sized nodule within the right middle lobe (Panel C, arrow). A screen for antineuronal antibodies identified anti-Hu. This antibody is usually found in patients with neuroendocrine lung carcinomas in the context of a paraneoplastic neurologic syndrome. It has been implicated in the development of tonic pupils, autonomic dysfunction, and painful sensory neuropathies. The pulmonary lesion was excised, and a localized large-cell neuroendocrine tumor was confirmed. The clinical presentation and the presence of anti-Hu enabled us to predict the primary pathological abnormality in this case. The patient received three cycles of adjuvant chemotherapy (carboplatin and etoposide), and she has subsequently shown a steady improvement, with weight gain and a slow resolution of her sensory and autonomic symptoms.
William C. Gordon, M.R.C.P.
Michael T.J. Leach, M.R.C.Path.
Stobhill Hospital
Glasgow G21 3UW, United Kingdom
William C. Gordon, M.R.C.P.
Michael T.J. Leach, M.R.C.Path.
Stobhill Hospital
Glasgow G21 3UW, United Kingdom