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Marcha cautelosa con debilidad proximal en miembros inferiores y abolici&#243;n de reflejos tricipitales&#44; rotulianos y aqu&#237;leos&#46; Fue remitido al servicio de neurolog&#237;a decidi&#233;ndose su ingreso hospitalario&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">La anal&#237;tica general no fue relevante&#46; El proteinograma y el an&#225;lisis de LCR fueron normales&#44; as&#237; como los marcadores tumorales AFP&#44; CEA&#44; Ca 125&#44; Ca 19&#46;9&#44; Ca 15&#46;3 y PSA&#46; La radiograf&#237;a de t&#243;rax no mostr&#243; hallazgos patol&#243;gicos de inter&#233;s&#46; El estudio neurofisiol&#243;gico fue compatible con una polineuropat&#237;a de naturaleza desmielinizante&#46; El TAC craneal mostr&#243; atrofia frontotemporal bilateral y el TAC tor&#225;cico inicial fue normal&#46; La resonancia magn&#233;tica c&#233;rvico-dorso-lumbar mostr&#243; &#250;nicamente una protrusi&#243;n discal foraminal sin compromiso radicular&#46; En el estudio de anticuerpos&#44; los antigangli&#243;sidos y anti-MAG &#40;antiglicoprote&#237;na asociada a la mielina&#41; fueron negativos&#44; mientras que los anti-Hu fueron positivos&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Ante la alta sospecha de proceso neopl&#225;sico se realiz&#243; PET-TC que mostr&#243; foco levemente hipermetab&#243;lico sobre un peque&#241;o infiltrado pulmonar derecho subpleural basal y gran foco hipermetab&#243;lico mediast&#237;nico subcarinal de 3<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>cm &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Tras estos hallazgos se realiz&#243; broncoscopia flexible que no evidenci&#243; hallazgos patol&#243;gicos endobronquiales&#46; Se realizaron punciones en regi&#243;n G7&#44; resultando el estudio citol&#243;gico de las muestras obtenidas diagn&#243;stico para carcinoma broncog&#233;nico anapl&#225;sico de c&#233;lulas peque&#241;as&#46; El paciente fue remitido para tratamiento al servicio de oncolog&#237;a&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Los s&#237;ndromes paraneopl&#225;sicos &#40;SP&#41; son entidades bien conocidas asociadas a un tumor maligno&#44; que pueden afectar a cualquier &#243;rgano o tejido del cuerpo&#46; El SP se presenta en aproximadamente el 10&#37; de los pacientes con un tumor maligno pulmonar&#44; y es m&#225;s frecuente en el carcinoma microc&#237;tico<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46; Aunque la mayor&#237;a de las complicaciones neurol&#243;gicas del c&#225;ncer de pulm&#243;n son de origen metast&#225;sico&#44; existen una serie de SP neurol&#243;gicos&#44; y dentro de ellos el m&#225;s frecuente es la polineuropat&#237;a&#46; Cl&#237;nicamente la polineuropat&#237;a paraneopl&#225;sica se caracteriza por el desarrollo subagudo de alteraciones asim&#233;tricas sensoriales como dolor&#44; parestesias y entumecimiento que afecta distalmente a las extremidades<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#46; La polineuropat&#237;a puede preceder en m&#225;s de un a&#241;o al diagn&#243;stico del c&#225;ncer&#44; como ocurri&#243; en nuestro caso&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">En un adulto con polineuropat&#237;a perif&#233;rica e historia de tabaquismo prolongado&#44; la seropositividad de los autoanticuerpos nucleares anti-neuronales tipo 1 &#40;ANNA-1&#41; tambi&#233;n denominados anti-Hu es un marcador de carcinoma microc&#237;tico de pulm&#243;n<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#46; El mecanismo patog&#233;nico de estos anticuerpos ser&#237;a por acumulaci&#243;n intraneuronal de los mismos en el sistema nervioso&#46; Estos anticuerpos pueden detectarse en pacientes con carcinoma microc&#237;tico sin s&#237;ntomas neurol&#243;gicos&#44; 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Carta al Director
Neuropatía paraneoplásica con anti-Hu positivo. A propósito de un caso
Paraneoplastic neuropathy with positive anti-Hu. A case report
María del Mar Valenzuela Membrivesa,
Corresponding author
marivalen8@hotmail.com

Autor para correspondencia.
, María Sánchez Palopa, Javier Esquivias Lópezb
a Unidad de Gestión Clínica de Neumología, Hospital Universitario San Cecilio, Granada, España
b Servicio de Anatomía Patológica, Hospital Universitario Virgen de las Nieves, Granada, España
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Presentamos el caso de un var&#243;n de 73 a&#241;os&#184; con antecedentes de tabaquismo activo con un ICAT de 60 paquetes&#47;a&#241;o&#44; antiguo h&#225;bito et&#237;lico&#44; hipertensi&#243;n arterial y cardiopat&#237;a isqu&#233;mica con un infarto agudo de miocardio hac&#237;a 15 a&#241;os&#46; Consult&#243; por un cuadro de un a&#241;o de evoluci&#243;n consistente en dolor&#44; debilidad y parestesias en miembros superiores&#44; as&#237; como dolor a nivel lumbar&#46; Refer&#237;a tambi&#233;n tos&#44; expectoraci&#243;n mucopurulenta y disnea de peque&#241;os esfuerzos&#44; sin s&#237;ndrome t&#243;xico asociado&#46; En la exploraci&#243;n f&#237;sica presentaba ligera taquipnea e hipofonesis generalizada bilateral sin ruidos adventicios&#46; Examen neurol&#243;gico&#58; no alteraciones campim&#233;tricas ni de pares craneales&#44; con fuerza conservada&#46; Marcha cautelosa con debilidad proximal en miembros inferiores y abolici&#243;n de reflejos tricipitales&#44; rotulianos y aqu&#237;leos&#46; Fue remitido al servicio de neurolog&#237;a decidi&#233;ndose su ingreso hospitalario&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">La anal&#237;tica general no fue relevante&#46; El proteinograma y el an&#225;lisis de LCR fueron normales&#44; as&#237; como los marcadores tumorales AFP&#44; CEA&#44; Ca 125&#44; Ca 19&#46;9&#44; Ca 15&#46;3 y PSA&#46; La radiograf&#237;a de t&#243;rax no mostr&#243; hallazgos patol&#243;gicos de inter&#233;s&#46; El estudio neurofisiol&#243;gico fue compatible con una polineuropat&#237;a de naturaleza desmielinizante&#46; El TAC craneal mostr&#243; atrofia frontotemporal bilateral y el TAC tor&#225;cico inicial fue normal&#46; La resonancia magn&#233;tica c&#233;rvico-dorso-lumbar mostr&#243; &#250;nicamente una protrusi&#243;n discal foraminal sin compromiso radicular&#46; En el estudio de anticuerpos&#44; los antigangli&#243;sidos y anti-MAG &#40;antiglicoprote&#237;na asociada a la mielina&#41; fueron negativos&#44; mientras que los anti-Hu fueron positivos&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Ante la alta sospecha de proceso neopl&#225;sico se realiz&#243; PET-TC que mostr&#243; foco levemente hipermetab&#243;lico sobre un peque&#241;o infiltrado pulmonar derecho subpleural basal y gran foco hipermetab&#243;lico mediast&#237;nico subcarinal de 3<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>cm &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Tras estos hallazgos se realiz&#243; broncoscopia flexible que no evidenci&#243; hallazgos patol&#243;gicos endobronquiales&#46; Se realizaron punciones en regi&#243;n G7&#44; resultando el estudio citol&#243;gico de las muestras obtenidas diagn&#243;stico para carcinoma broncog&#233;nico anapl&#225;sico de c&#233;lulas peque&#241;as&#46; El paciente fue remitido para tratamiento al servicio de oncolog&#237;a&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Los s&#237;ndromes paraneopl&#225;sicos &#40;SP&#41; son entidades bien conocidas asociadas a un tumor maligno&#44; que pueden afectar a cualquier &#243;rgano o tejido del cuerpo&#46; El SP se presenta en aproximadamente el 10&#37; de los pacientes con un tumor maligno pulmonar&#44; y es m&#225;s frecuente en el carcinoma microc&#237;tico<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46; Aunque la mayor&#237;a de las complicaciones neurol&#243;gicas del c&#225;ncer de pulm&#243;n son de origen metast&#225;sico&#44; existen una serie de SP neurol&#243;gicos&#44; y dentro de ellos el m&#225;s frecuente es la polineuropat&#237;a&#46; Cl&#237;nicamente la polineuropat&#237;a paraneopl&#225;sica se caracteriza por el desarrollo subagudo de alteraciones asim&#233;tricas sensoriales como dolor&#44; parestesias y entumecimiento que afecta distalmente a las extremidades<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#46; La polineuropat&#237;a puede preceder en m&#225;s de un a&#241;o al diagn&#243;stico del c&#225;ncer&#44; como ocurri&#243; en nuestro caso&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">En un adulto con polineuropat&#237;a perif&#233;rica e historia de tabaquismo prolongado&#44; la seropositividad de los autoanticuerpos nucleares anti-neuronales tipo 1 &#40;ANNA-1&#41; tambi&#233;n denominados anti-Hu es un marcador de carcinoma microc&#237;tico de pulm&#243;n<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#46; El mecanismo patog&#233;nico de estos anticuerpos ser&#237;a por acumulaci&#243;n intraneuronal de los mismos en el sistema nervioso&#46; Estos anticuerpos pueden detectarse en pacientes con carcinoma microc&#237;tico sin s&#237;ntomas neurol&#243;gicos&#44; pero no en personas sanas<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#46; El manejo de este s&#237;ndrome incluye el tratamiento del c&#225;ncer subyacente&#44; aunque generalmente no suele mejorar el cuadro neurol&#243;gico&#44; que progresa de forma r&#225;pida<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#46;</p></span>"
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Article information
ISSN: 03002896
Original language: Spanish
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