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An elderly man with a lung mass and neurological symptoms -- The authors describe a case of paraneoplastic syndrome associated with small-cell lung cancer and the presence of anti-Hu antibodies.

Article Excerpt
Byline: NIRAV P. PATEL, MD and NALAKA GOONERATNE, MD

The case

A 71-year-old man with small-cell lung cancer (SCLC) was admitted to the medical ICU from another hospital for management of difficulty in weaning from mechanical ventilation. At the previous hospital, he had presented with constitutional symptoms, including fatigue, malaise, and a 15-lb weight loss, and neurological symptoms, such as dizziness, syncope attacks, and progressive weakness.

MRI and CT scans of the head did not reveal any abnormalities. His chest radiograph showed a mass in the right lung field (Figure). A CT scan of the chest revealed an incidental mediastinal mass. A bronchoscopic biopsy specimen revealed a SCLC of limited stage. One cycle of chemotherapy with cisplatin and etoposide was administered.

Hospital staff and family members noted extreme lethargy and somnolence. Numbness, parasthesia, and tremor were noted in addition to a generalized tonic-clonic seizure. The occurrence of the seizure prompted intubation. Acute hypercapneic respiratory failure developed when the patient was extubated, thus requiring reintubation. Discussions with family and friends revealed a gradually progressive illness characterized by neurological symptoms of cognitive impairment, mood swings, somnolence, and limb weakness but no respiratory complaints.

On physical examination, the patient was intubated, somnolent without sedation, and comfortable. Lung and cardiac examination findings were normal. Cranial nerves were normal except for rotatory...

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