Chronic inflammatory demyelinating polyneuropathy, diagnosed as a paraneoplastic manifestation of small cell neuroendocrine carcinoma of the cervix

Abstract

Paraneoplastic syndrome frequently presents before cancer is diagnosed and can be associated with neoplastic disease that is not yet radiographically detectable. We report on the case of a 35-year-old woman who presented at the neurology department with complaints of insidious onset and gradually progressive weakness in all four limbs, which had lasted for the past six months. The weakness originally commenced in both lower limbs and was progressive, ascending in nature from distal to proximal. Both upper limbs were affected seven days later. Magnetic resonance imaging of the dorsal spine revealed long-segment T2 and short T1 inversion recovery (STIR) hyperintensity, suggestive of myelitis. Nerve conduction studies and an electromyogram suggested sensory motor polyneuropathy which affected all four limbs. On gynaecological check-up, a diagnosis of International Federation of Gynaecology and Obstetrics (FIGO) stage IIB carcinoma cervix was made. Histology diagnosed it as a case of small cell neuroendocrine carcinoma. Thus, a diagnosis of chronic inflammatory demyelinating polyneuropathy, arising as a paraneoplastic syndrome in the carcinoma cervix, was made. The patient was treated with chemotherapy, steroids and radical radiotherapy. She recovered partially from her motor deficiencies and completely from her sensory derangement, and was devoid of gynaecological complaints. The cancer growth regressed completely.