INDOLENT ANTI-HU-ASSOCIATED PARANEOPLASTIC SENSORY NEUROPATHY

Paraneoplastic sensory neuropathy (PSN) usually runs a subacute progre ssive course, leaving the patient with severe sensory dysfunction in w eeks to months. We describe five patients with PSN, high titers of ant i-Hu antibodies (type 1 antineuronal nuclear autoantibodies), and an i ndolent clinical course. The patients had a median age of 55 years (ra nge, 41 to 72). Four had small-cell (3) or undifferentiated large-cell (1) lung cancer. Patients presented with mild, asymmetric sensory sym ptoms; in two, the neuropathy was predominant in the arms. Two patient s also had a visceral neuropathy causing gastrointestinal dysfunction. The PSN was stable or progressed very slowly without treatment for a median of 18 months (range, 5 to 32) and remained so after treatment w ith immunoglobulins (1 patient), chemotherapy (3), or both therapies ( 1). All patients were ambulatory, leading an independent life up until the time of the last visit or until death from the tumor (2 patients) . The median follow-up was 36 months (range, 22 to 52). A paraneoplast ic origin should be considered in patients with mild, very slowly prog ressive sensory neuropathies.