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Paraneoplastic mononeuritis multiplex in non-small-cell lung carcinoma
Annabel C Martin1, Michael Friedlander, Matthew C Kiernan
1Prince of Wales Medical Research Institute, Barker Street, Randwick, Sydney, New South Wales 2031, Australia.
Summary
A rare case of paraneoplastic mononeuritis multiplex occurred in a patient with large-cell lung carcinoma. This condition, affecting peripheral nerves, did not respond to treatment, leading to a poor prognosis.
Area of Science:
- Neurology
- Oncology
Background:
- Paraneoplastic syndromes can manifest as neurological disorders secondary to cancer.
- Peripheral neuropathies, particularly mononeuritis multiplex, are recognized but less common neurological paraneoplastic manifestations.
Observation:
- A 60-year-old male diagnosed with large-cell lung carcinoma developed sequential, selective peripheral mononeuropathies affecting the peroneal and radial nerves.
- Nerve conduction studies and electromyography revealed isolated nerve lesions with focal conduction block in the peroneal nerve.
- Magnetic resonance imaging ruled out mechanical compression or direct tumor infiltration of the affected nerves.
Findings:
- The clinical presentation and diagnostic workup supported a diagnosis of paraneoplastic mononeuritis multiplex.
- Negative results for anti-neuronal antibodies and vasculitis markers excluded other potential causes.
- The patient's lung carcinoma and the mononeuritis multiplex were refractory to chemotherapy.
Implications:
- This case highlights the importance of considering paraneoplastic neurological syndromes in cancer patients presenting with unexplained peripheral neuropathies.
- The selective nature and focal conduction block in mononeuritis multiplex can be a paraneoplastic sign.
- The poor response to treatment underscores the challenges in managing paraneoplastic neurological disorders and their association with advanced malignancy.
