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Letter to the Editor
Paraneoplastic Neuropathy With Positive Anti-Hu. A Case Report
Neuropatía paraneoplásica con anti-Hu positivo. A propósito de un caso
María del Mar Valenzuela Membrivesa,
Corresponding author
marivalen8@hotmail.com

Corresponding author.
, María Sánchez Palopa, Javier Esquivias Lópezb
a Unidad de Gestión Clínica de Neumología, Hospital Universitario San Cecilio, Granada, Spain
b Servicio de Anatomía Patológica, Hospital Universitario Virgen de las Nieves, Granada, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We report the case of a 73-year-old man&#44; active smoker with a history of 60 pack-years&#44; a former alcohol habit&#44; hypertension and ischemic heart disease&#44; with acute myocardial infarction 15 years previously&#46; He was seen for a 12-month history of pain&#44; weakness and paresthesia in the lower limbs&#44; and lumbago&#46; He also reported cough&#44; mucopurulent expectoration and dyspnea on slight exertion&#44; with no associated toxic syndrome&#46; Physical examination revealed mild tachypnea and generalized bilateral diminished breath sounds with no adventitious sounds&#46; Neurological examination showed no changes in campimetry or cranial nerves&#44; and functional tests were normal&#46; Gait was cautious&#44; with proximal weakness of the lower limbs and loss of triceps&#44; patellar and Achilles reflexes&#46; The patient was referred to the neurology department&#44; from where he was admitted to hospital&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">General laboratory tests showed no significant findings&#46; Protein levels and cerebrospinal fluid were normal&#44; as were tumor markers AFP&#44; CEA&#44; Ca 125&#44; Ca 19&#46;9&#44; Ca 15&#46;3 and PSA&#46; No pathological findings were seen on chest X-ray&#46; The neurophysiological examination suggested demyelinating polyneuropathy&#46; Head computed tomography &#40;CT&#41; showed bilateral frontotemporal atrophy&#44; and the initial chest CT was normal&#46; Magnetic resonance imaging of the cervical&#44; dorsal and lumbar spine revealed only a foraminal disc protusion with no radicular involvement&#46; An antibody study was negative for antigangliosides and anti-MAG &#40;anti-myelin-associated glycoprotein&#41; and positive for anti-Hu antibodies&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">In view of the strong suspicion of a neoplastic process&#44; PET-CT was performed&#44; revealing a slightly hypermetabolic focus over a small infiltrate in the right subpleural lung base&#44; and a large hypermetabolic focus in the subcarinal mediastinum&#44; 3<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>cm in size &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">No pathological endobronchial findings were observed on flexible bronchoscopy&#46; Aspirates were obtained from the G7 region&#44; and the cytological examination of these samples provided a diagnosis of small-cell anaplastic bronchogenic carcinoma&#46; The patient was referred to the oncology department for treatment&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The association of paraneoplastic syndromes &#40;PSs&#41; with malignant tumors is well known&#44; and any body organ or tissue can be affected&#46; PS occurs in approximately 10&#37; of the patients with lung malignancies&#44; and is more common in small-cell carcinoma&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Although most of the neurological complications of lung cancer are due to metastases&#44; there are several neurological PSs&#44; one of the most common being polyneuropathy&#46; Clinical features of paraneoplastic polyneuropathy include the subacute development of asymmetric sensorial changes&#44; such as pain&#44; paresthesia and numbness affecting the distal extremities&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Polyneuropathy can appear more than 1 year before the diagnosis of cancer&#44; as occurred in our case&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">In an adult with peripheral polyneuropathies and a long-term history of smoking&#44; seropositivity for anti-neuronal nuclear autoantibodies type-1 &#40;ANNA-1&#41;&#44; also known as anti-Hu&#44; is a marker for small-cell lung cancer&#46;<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&#46; These antibodies can be detected in small-cell carcinoma patients without neurological symptoms&#44; but not in healthy subjects&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> Management of this syndrome includes treatment of the underlying cancer&#44; but this does not generally help the neurological symptoms&#44; which tend to progress rapidly&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Valenzuela Membrives MM&#44; S&#225;nchez Palop M&#44; Esquivias L&#243;pez J&#46; Neuropat&#237;a paraneopl&#225;sica con anti-Hu positivo&#46; A prop&#243;sito de un caso&#46; Arch Bronconeumol&#46; 2015&#59;51&#58;252&#8211;253&#46;</p>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chest PET-CT image&#46; A large hypermetabolic focus is seen in the subcarinal lymph node station &#40;G7&#41;&#46;</p>"
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Article information
ISSN: 15792129
Original language: English
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