Title |
Paraneoplastic Retinopathy |
Creator |
Murphy, MA; Thirkill, CE; Hart, WM |
Affiliation |
Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri 63110-1093, USA. |
Abstract |
We present the case of a 74-year-old man with rapidly progressive bilateral visual loss, optic disc pallor, retinal arteriolar attenuation, and an abnormal electroretinogram with a 90% reduction in cone function and a 50% reduction in rod function. He was examined for a suspected cancer-associated retinopathy (CAR). Although he was found not to have expressed the previously reported 23-kd CAR antibody, high titers were found of an antibody to a 60-kd retinal protein, which as yet remains unidentified. An initial clinical search for an underlying cancer was unsuccessful, but 2 months later a mediastinal mass was found on chest x-rays, and biopsy confirmed a diagnosis of small-cell lung carcinoma. Combined therapy with oral corticosteroids and plasmapheresis resulted in a recovery of vision from counting fingers to 20/200 in the right eye and 20/40 to 20/25 in the left eye. Conventional chemotherapeutic management of the small-cell lung carcinoma was instituted, and the modest visual recovery was maintained. The visual improvement as well as lung tumor regression were accompanied by a decline in antibody titers from 1:2,000 pretreatment to 1:200 during the course of therapy. The absence of reactivity with the previously described 23-kd retinal antigen of the CAR syndrome does not exclude the diagnosis of paraneoplastic retinopathy in patients fitting the clinical profile of this disease. |
Subject |
Older people; Antibodies, Neoplasm/immunology; Autoantibodies/analysis; Blotting, Western; Carcinoma, Small Cell/immunology; Carcinoma, Small Cell/pathology; Carcinoma, Small Cell/therapy; Eye Proteins/immunology; Glucocorticoids/therapeutic use; Humans; Lung Neoplasms/immunology; Lung Neoplasms/pathology; Lung Neoplasms/therapy; Male; Paraneoplastic Syndromes/immunology; Paraneoplastic Syndromes/pathology; Paraneoplastic Syndromes/therapy; Plasmapheresis; Prednisone/therapeutic use; Retina/immunology; Retinal Diseases/immunology; Retinal Diseases/pathology; Retinal Diseases/therapy; Visual Acuity; Visual Fields |
OCR Text |
Show Lippincott, Williams & Wilkins |
Format |
application/pdf |
Publication Type |
Journal Article |
Collection |
Neuro-Ophthalmology Virtual Education Library: Journal of Neuro-Ophthalmology Archives: https://novel.utah.edu/jno/ |
Holding Institution |
Spencer S. Eccles Health Sciences Library, University of Utah |
Setname |
ehsl_novel_jno |
ID |
224807 |
Reference URL |
https://collections.lib.utah.edu/ark:/87278/s6dv4r0g/224807 |