Multiple Paraneoplastic Neurological and Rheumatological Syndromes Revealing an Ovarian Cancer

Vincent Boudousq,Eric Thouvenot,Ioana Maria Ion,Anca Badoiu,Morgane Petot

doi:10.31487/j.cor.2021.11.01

Abstract

Multiple paraneoplastic syndromes are a rare clinical manifestation. We describe the case of an 82-year-old woman who presented with neurological (rapidly progressive cerebellar syndrome and combined sensory-motor neuronopathy) and rheumatological (palmar fasciitis and polyarthritis syndrome) paraneoplastic syndromes associated with two onconeural antibodies (anti-Yo and Zic4), that revealed an ovarian cancer. The involvement of multiple organ systems should be a clue to take into consideration a paraneoplastic etiology that could permit early detection of cancer. However, despite the existence of treatments, the prognosis of these conditions remains poor.

Highlights

Paraneoplastic syndromes are remote, immune-mediated effects of cancer on different organs and systems, not caused by the tumor and its metastasis, nor by infection, ischaemia, or metabolic disruptions [1]
We describe the case of an 82-year-old woman who presented with neurological and rheumatological paraneoplastic syndromes associated with two onconeural antibodies, that revealed an ovarian cancer
A diagnosis of paraneoplastic combined sensory and motor neuronopathy, rapidly progressive cerebellar syndrome and palmar fasciitis and polyarthritis syndrome were retained as remote effects of an ovarian cancer

Summary

Introduction

Paraneoplastic syndromes are remote, immune-mediated effects of cancer on different organs and systems, not caused by the tumor and its metastasis, nor by infection, ischaemia, or metabolic disruptions [1]. An 82-year-old woman presented with a four-month history of gait disturbances, asymmetric painful tingling in her fingertips gradually extended to her toes. She reported pain and swelling in her hands and wrists and unintentional weight loss. Her background history includes atrial fibrillation and arterial hypertension. Whole body 18F-FDG-PET showed an increased metabolism of bilateral adnexal masses (left 28 × 33 mm, right 15×10mm in axial section) with sub- and supra-diaphragmatic lymphadenopathies and increased uptake at the level of wrist joints (Figures 2B-2D). A diagnosis of paraneoplastic combined sensory and motor neuronopathy, rapidly progressive cerebellar syndrome and palmar fasciitis and polyarthritis syndrome were retained as remote effects of an ovarian cancer. After three months she deteriorated clinically with global motor weakness that confined her to bed and the patient along with the family opted for palliative care

Discussion

Conclusion