PARANEOPLASTIC NEUROPATHY WITH POSITIVE A NTI-HU

The case of a 72-year-old woman presenting sensory neuropathy and anti -Hu antibodies is reported. She was admitted in November 1995 with a o ne year history of sensory neuropathy. Her first sympoms were painful numbness and dysesthesias in both feet. She experienced progression of the sensory symptoms affecting upper limbs, and clumsiness of gait. O ne month before admission she complained of diminished strength in bot h hands. The neurologic examination showed anisocoric fixed pupils, wi th no reaction to light; convergence miosis was evident in the right e ye (Argyll-Robertson pupil). In the lower limbs she had very mild dist al weakness, and tendon reflexes were universally abolished. Pin and t ouch sensation, position sense and pallesthesia were absent in all fou r limbs. Romberg test was elicited, and a tabetic gait was patent. Pse udoathetotic movements were observed in hands and feet. An ulcer was p resent in the fifth finger of the right foot. Routine blood biochemist ry and hematology showed a ESR of 105 and an increased IgG in the immu ne-electrophoretic run. Neurophysiologic evaluation disclosed a mild d emyelinating neuropathy. Positive anti-Hu antibodies were found in the serum (Western blot - Athena Diagnostics); CSF was normal but not tes ted for anti-Hu. An abdominal CT scan disclosed multiple hypodense nod ules in liver, right adrenal gland and peritoneum. A chest CT scan sho wed a hyperdense mass in the lower right pulmonary lobe and enlarged r etrocava-pretracheal lymph nodes. A biopsy of the peritoneal nodule wa s performed, showing a metastatic small cell carcinoma. The patient di ed eight days after discharge. Although multiple organs were affected, she was independent until death, showing an indolent clinical course.