Paraneoplastic sensorimotor neuropathy associated with mediastinal germ cell tumor: favorable outcome after high-dose in
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LETTER TO THE EDITOR
Paraneoplastic sensorimotor neuropathy associated with mediastinal germ cell tumor: favorable outcome after high-dose intravenous immunoglobulin therapy Kazumasa Shindo 1
&
Mai Tsuchiya 1 & Kishin Koh 1 & Takamura Nagasaka 1 & Yoshihisa Takiyama 1
Received: 4 December 2018 / Accepted: 11 September 2019 # Fondazione Società Italiana di Neurologia 2019
Dear Editor, Paraneoplastic neuropathy caused by anti-neuronal antibodies is more often a sensory than sensorimotor neuropathy [1, 2]. Anti-Hu antibody is an anti-neuronal antibody that is known to be associated with small cell or non-small cell lung cancer [1]. In addition, a few cases of paraneoplastic neuropathy due to anti-Hu antibody have been reported in patients with mediastinal tumors such as thymoma [3]. Germ cell tumor (GCT) has a relatively high incidence among young men and generally arises in the testis, but 2–6% of patients with GCT have a primary mediastinal tumor [4]. To the best of our knowledge, this article describes the first case report of sensorimotor neuropathy associated with mediastinal GCT. A 35-year-old man initially presented with a 3-month history of subjective clumsiness of his left hand, followed by gradually progressive muscle weakness affecting the left hand from 8 months after the onset. He described difficulty maintaining his balance at night and difficulty using stairs. This patient was admitted to our hospital at 13 months after the onset. The past medical history was noncontributory. He did not smoke tobacco or drink alcohol. Neurological examination revealed mild distal muscle weakness of both arms (left dominant) and decreased deep tendon reflexes. He showed loss of joint position and vibration sensation in the distal left arm and leg. He was not able to walk unaided because of severe sensory ataxia.
* Kazumasa Shindo [email protected] 1
Department of Neurology, University of Yamanashi, 1110 Shimokatou, Yamanashi 409-3898, Japan
Romberg’s sign was positive. Pseudoathetosis of the left hand was observed. There were no signs of cerebellar or autonomic involvement. Laboratory tests revealed that the complete blood count, serum chemistry parameters, plasma glucose, antibodies related to systemic lupus erythematosus and systemic or non-systemic vasculitic disorders, vitamin B1, and vitamin B12 were all within normal limits. In addition, the cerebrospinal fluid cell count and protein level were normal. There was no abnormal finding such as cerebellar atrophy by brain magnetic resonance imaging. On plain and enhanced chest computed tomography (CT), significant findings were not detected. Abdominal ultrasound, computed tomography, gastroscopy, and wholebody gallium scintigraphy were all normal. Nerve conduction studies (NCS) showed loss of the sensory nerve action potential of the left median nerve, slight delay of the sensory nerve conduction velocity (38 m/s) on the right side, a marked decrease of action potential amplitude in the bilateral ulnar nerves (right; 0.2 μV, left; 1.5 μV), and bilateral lo
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