Reversible autonomic neuropathy and hypertrophic osteoarthropathy in a patient with bronchogenic carcinoma

We report a case of adenocarcinoma of the lung with pandysautonomia and pulmonary osteoarthropathy. Surgical resection of the tumor followed by radiation therapy for the residual tumor resulted in complete resolution of arthropathy and almost complete recovery from autonomic dysfunction. The symptoms of arthropathy and autonomic neuropathy recurred simultaneously several months later with increase in the tumor mass as confirmed at second surgical exploration. The second thoracotomy revealed an inoperable tumor. Following the second thoracotomy, while the arthropathy was relieved, the autonomic neuropathy persisted. We concluded that autonomic neuropathy is related to the tumor mass, and pulmonary osteoarthropathy and autonomic neuropathy are probably caused by different mechanisms, as yet undefined.