Letter to the Editor
Paraneoplastic Neuropathy With Positive Anti-Hu. A Case Report
Neuropatía paraneoplásica con anti-Hu positivo. A propósito de un caso
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Anti-Hu. A Case Report" "tieneTextoCompleto" => true "saludo" => "To the Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "252" "paginaFinal" => "253" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "María del Mar Valenzuela Membrives, María Sánchez Palop, Javier Esquivias López" "autores" => array:3 [ 0 => array:4 [ "nombre" => "María del Mar" "apellidos" => "Valenzuela Membrives" "email" => array:1 [ 0 => "marivalen8@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "María" "apellidos" => "Sánchez Palop" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Javier" "apellidos" => "Esquivias López" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Unidad de Gestión Clínica de Neumología, Hospital Universitario San Cecilio, Granada, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Universitario Virgen de las Nieves, Granada, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Neuropatía paraneoplásica con anti-Hu positivo. A propósito de un caso" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1167 "Ancho" => 1800 "Tamanyo" => 272099 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chest PET-CT image. A large hypermetabolic focus is seen in the subcarinal lymph node station (G7).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We report the case of a 73-year-old man, active smoker with a history of 60 pack-years, a former alcohol habit, hypertension and ischemic heart disease, with acute myocardial infarction 15 years previously. He was seen for a 12-month history of pain, weakness and paresthesia in the lower limbs, and lumbago. He also reported cough, mucopurulent expectoration and dyspnea on slight exertion, with no associated toxic syndrome. Physical examination revealed mild tachypnea and generalized bilateral diminished breath sounds with no adventitious sounds. Neurological examination showed no changes in campimetry or cranial nerves, and functional tests were normal. Gait was cautious, with proximal weakness of the lower limbs and loss of triceps, patellar and Achilles reflexes. The patient was referred to the neurology department, from where he was admitted to hospital.</p><p id="par0010" class="elsevierStylePara elsevierViewall">General laboratory tests showed no significant findings. Protein levels and cerebrospinal fluid were normal, as were tumor markers AFP, CEA, Ca 125, Ca 19.9, Ca 15.3 and PSA. No pathological findings were seen on chest X-ray. The neurophysiological examination suggested demyelinating polyneuropathy. Head computed tomography (CT) showed bilateral frontotemporal atrophy, and the initial chest CT was normal. Magnetic resonance imaging of the cervical, dorsal and lumbar spine revealed only a foraminal disc protusion with no radicular involvement. An antibody study was negative for antigangliosides and anti-MAG (anti-myelin-associated glycoprotein) and positive for anti-Hu antibodies.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In view of the strong suspicion of a neoplastic process, PET-CT was performed, revealing a slightly hypermetabolic focus over a small infiltrate in the right subpleural lung base, and a large hypermetabolic focus in the subcarinal mediastinum, 3<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>cm in size (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">No pathological endobronchial findings were observed on flexible bronchoscopy. Aspirates were obtained from the G7 region, and the cytological examination of these samples provided a diagnosis of small-cell anaplastic bronchogenic carcinoma. The patient was referred to the oncology department for treatment.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The association of paraneoplastic syndromes (PSs) with malignant tumors is well known, and any body organ or tissue can be affected. PS occurs in approximately 10% of the patients with lung malignancies, and is more common in small-cell carcinoma.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Although most of the neurological complications of lung cancer are due to metastases, there are several neurological PSs, one of the most common being polyneuropathy. Clinical features of paraneoplastic polyneuropathy include the subacute development of asymmetric sensorial changes, such as pain, paresthesia and numbness affecting the distal extremities.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Polyneuropathy can appear more than 1 year before the diagnosis of cancer, as occurred in our case.</p><p id="par0030" class="elsevierStylePara elsevierViewall">In an adult with peripheral polyneuropathies and a long-term history of smoking, seropositivity for anti-neuronal nuclear autoantibodies type-1 (ANNA-1), also known as anti-Hu, is a marker for small-cell lung cancer.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> The pathogenic mechanism of these antibodies is probably due to these antibodies accumulating in the neurons of the nervous system. These antibodies can be detected in small-cell carcinoma patients without neurological symptoms, but not in healthy subjects.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> Management of this syndrome includes treatment of the underlying cancer, but this does not generally help the neurological symptoms, which tend to progress rapidly.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Valenzuela Membrives MM, Sánchez Palop M, Esquivias López J. Neuropatía paraneoplásica con anti-Hu positivo. A propósito de un caso. Arch Bronconeumol. 2015;51:252–253.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1167 "Ancho" => 1800 "Tamanyo" => 272099 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chest PET-CT image. A large hypermetabolic focus is seen in the subcarinal lymph node station (G7).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Paraneoplastic neurological syndrome as an initial indicator of small cell carcinoma of the lung" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "L. Porto" 1 => "M. Miranda" 2 => "A. Gomes" 3 => "R. André" 4 => "B. 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Dansin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rmr.2013.03.004" "Revista" => array:6 [ "tituloSerie" => "Rev Mal Respir" "fecha" => "2013" "volumen" => "30" "paginaInicial" => "563" "paginaFinal" => "566" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24034461" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Plasmapheresis and antineoplastic treatment in CNS paraneoplastic syndromes with antineuronal autoantibodies" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Graus" 1 => "F. Vega" 2 => "J.Y. Delattre" 3 => "I. Bonaventura" 4 => "R. René" 5 => "D. Arbaiza" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Neurology" "fecha" => "1992" "volumen" => "42" "paginaInicial" => "536" "paginaFinal" => "540" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1312683" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005100000005/v2_201504270531/S1579212915000609/v2_201504270531/en/main.assets" "Apartado" => array:4 [ "identificador" => "14576" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Letters to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005100000005/v2_201504270531/S1579212915000609/v2_201504270531/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212915000609?idApp=UINPBA00003Z" ]
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| 2018 May | 13 | 0 | 13 |
| 2018 April | 39 | 4 | 43 |
| 2018 March | 27 | 2 | 29 |
| 2018 February | 36 | 6 | 42 |
| 2018 January | 17 | 11 | 28 |
| 2017 December | 33 | 4 | 37 |
| 2017 November | 38 | 5 | 43 |
| 2017 October | 37 | 7 | 44 |
| 2017 September | 28 | 14 | 42 |
| 2017 August | 48 | 10 | 58 |
| 2017 July | 43 | 7 | 50 |
| 2017 June | 56 | 21 | 77 |
| 2017 May | 46 | 8 | 54 |
| 2017 April | 33 | 7 | 40 |
| 2017 March | 31 | 5 | 36 |
| 2017 February | 23 | 10 | 33 |
| 2017 January | 13 | 6 | 19 |
| 2016 December | 26 | 6 | 32 |
| 2016 November | 41 | 14 | 55 |
| 2016 October | 41 | 14 | 55 |
| 2016 September | 42 | 16 | 58 |
| 2016 August | 58 | 7 | 65 |
| 2016 July | 34 | 9 | 43 |
| 2016 March | 2 | 0 | 2 |
| 2016 February | 1 | 0 | 1 |
| 2015 December | 3 | 0 | 3 |
| 2015 October | 46 | 1 | 47 |
| 2015 September | 34 | 12 | 46 |
| 2015 August | 50 | 26 | 76 |
| 2015 July | 1 | 0 | 1 |
| 2015 June | 1 | 0 | 1 |
| 2015 April | 2 | 0 | 2 |
Show all
