By four cycles (7 months) of chemotherapy, strength and reflexes had returned to normal. Neurologic and ophthalmologic evaluations remain normal 16 months after the initial symptoms.
Discussion. This patient is remarkable because she had the association of PPNV and optic neuropathy, and because both paraneoplastic disorders resolved during treatment of the SCLC. In the absence of a paraneoplastic marker, such as antineuronal antibodies, one may question if the optic fundi abnormalities resulted from intracranial or leptomeningeal metastases. However, MRI of the head and CSF cytology did not show metastases. The presence of cells in the vitreous and inflammatory changes in the CSF were suggestive of an inflammatory or immunemediated disorder.
Microvasculitis in association with malignancy has been reported presenting as a mononeuritis multiplex before cancer diagnosis. CSF proteins and ESR are characteristically elevated. 2,3,4, Adenocarcinoma of the prostate and lung, Hodgkin's disease, and renal cell carcinoma are the most commonly associated tumors with this paraneoplastic disorder. 3,4, Some patients respond to treatment with either chemotherapeutic or immunosuppressive agents. 2,3, Paraneoplastic optic neuropathy is much less frequent than cancer-associated retinopathy, and dramatic responses to treatment are unknown. 1 In our patient it is tempting to speculate that the same inflammatory disorder that affected the peripheral nerves and SCLC also affected the optic nerves, resulting in bilateral ischemic optic neuropathy.
Our patient demonstrates that it is worthwhile to pursue the search of a tumor in patients with characteristic paraneoplastic symptoms, since not only the neurologic symptoms but also the primary neoplasm may improve with treatment.