Isolated right oculomotor nerve palsy as the first presenting manifestation of metastatic renal Ewing’s sarcoma

Abstract

Introduction: Extraskeletal Ewing’s sarcoma is a rare malignancy in the adult population, and its primary renal involvement is even rarer. Renal Ewing’s sarcoma is often metastatic at the initial presentation and has a poor prognosis. Patient concern: We present the case of a 53-year-old Filipino woman who presented to our emergency department with acute right oculomotor nerve palsy. Diagnosis: Imaging revealed metastatic lesions involving the skull and vertebra as well as the presence of a left kidney mass. Renal biopsy result of the kidney confirmed the diagnosis of renal Ewing's sarcoma. Intervention: The patient was started on doxorubicin, vincristine, and cyclophosphamide, alternating with ifosfamide and etoposide. Outcomes: The patient developed severe adverse effects from chemotherapy and died 4 months after diagnosis. Conclusion: To our knowledge, this is the first case of renal Ewing’s sarcoma that initially presented with neurological manifestations secondary to bone metastasis in the absence of any urological manifestations, such as flank pain or hematuria.