A case of paraneoplastic optic neuropathy in pancreatic adenocarcinoma
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LETTER TO THE EDITOR
A case of paraneoplastic optic neuropathy in pancreatic adenocarcinoma Chaeyeon Lee 1 & Shin Yeop Oh 2 & Kyung-Ah Park 1
&
Ga-In Lee 1 & Sei Yeul Oh 1
Received: 30 August 2020 / Accepted: 3 November 2020 # Fondazione Società Italiana di Neurologia 2020
Dear Editor, Paraneoplastic syndrome can present with diverse manifestations in various organs. Molecular mimicry is believed to underlie the development of the paraneoplastic syndromes [1]. Paraneoplastic optic neuropathy (PON) and cancerassociated retinopathy (CAR), the most common ocular presentations of paraneoplastic syndrome, are diagnosed based on the clinical presentation in the setting of an underlying malignancy and the detection of pathogenic autoantibodies such as collapsin response-mediator protein-5 (CRMP-5) antibody [2] and recoverin antibody [3]. The CRMP-5 antibody is the most frequently implicated antibody in PON and usually induces optic neuritis accompanied by retinal vascular leakage and vitritis [4]. The cancers which are known to be associated with PON include small-cell lung carcinoma [4, 5] and lymphoma [6]. On the other hand, recoverin is one of the retinal antigens located within retinal photoreceptors and is related to CAR. Pathogenic recoverin autoantibodies’ main manifestation is macular atrophy associated with photoreceptor loss [7], retinal vasculitis [8], and pigment epithelial degeneration [9]. Herein, we report the first case of bilateral optic neuropathy in a patient with pancreatic ductal adenocarcinoma who was positive for autoantibody against recoverin.
Chaeyeon Lee and Shin Yeop Oh contributed equally to the article as the first authors * Kyung-Ah Park [email protected] 1
Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, South Korea
2
Department of Ophthalmology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea
Case report A 60-year-old male complained of acute progressive blurred vision in the right eye for 2 weeks. He denied ocular pain or headache. Four months before presentation, he had been diagnosed with pancreatic ductal adenocarcinoma with multiple lymph node, bone, and liver metastases, and he was undergoing palliative chemotherapy (FOLFIRINOX: 5-fluorouracil, irinotecan, and oxaliplatin). The patient denied any other symptom except visual dimness in the right eye. He had no photosensitivity, photopsia, glare, night blindness, nor ataxia. Upon ocular examination, the best-corrected visual acuity registered 20/20 in both eyes, despite the sensation of diffuse blurriness in the right eye. Colour vision was decreased to 8.5/10 in the right eye and 9.5/10 in the left eye on Hardy Rand and Rittler Pseudoisochromatic Plates. There was a relative afferent pupillary defect in the right eye. A visual field test revealed an altitudinal inferior field defect in both eyes, with a larger field defect in the right eye than in the left (Fig. 1a). The anterior chambers and ante
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