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Abstract Details

A Case of Paraneoplastic Cerebellar Degeneration and Autonomic Neuropathy in a Patient with P/Q Type Calcium Channel and CRMP-5 Antibodies and Prostate Adenocarcinoma
Autoimmune Neurology
P11 - Poster Session 11 (11:45 AM-12:45 PM)

P/Q type calcium channel antibodies and CRMP-5 antibodies are associated with paraneoplastic cerebellar degeneration (PCD). CRMP-5 antibodies have also been associated with paraneoplastic autonomic neuropathy with orthostatic hypotension. CRMP-5 antibodies are most commonly associated with small cell lung cancer and thymoma.

We aim to discuss a rare case of two paraneoplastic syndromes in one patient with prostate adenocarcinoma. 

A 74 year old male with history of metastatic prostate adenocarcinoma presented with sudden onset vertigo and gait ataxia resulting in hospitalization. Evaluation included CT chest, abdomen and pelvis which revealed bony metastasis, enlarged para-aortic lymph nodes and right lower lobe pleural based nodule. MRI brain with and without contrast showed 3mm subtle enhancing lesion in the right periventricular white matter. Initial CSF studies showed elevated protein (125 mg/dL) and paraneoplastic CSF antibodies were positive for CRMP-5-IgG with a titer of 1:15360 and elevated P/Q type calcium channel antibodies (1.19 nmol/L). He underwent a 5 day course of IVIG. Repeat CSF studies after IVIG showed improved protein (95 mg/dL). He had clinical improvement in his vertigo and ataxia initially, however he declined over the following month with increased dizziness, persistent down beating nystagmus and dysmetria, and newly developed severe orthostatic hypotension.

CRMP-5 antibodies are rarely associated with prostate adenocarcinoma, but it has been reported in a case report by A. Aliprandi and colleagues in 2015. This is the first case to my knowledge of CRMP-5 autonomic neuropathy with prostate adenocarcinoma as the underlying cancer. This is also the first reported case with both autonomic neuropathy and PCD in the same patient with underlying prostate adenocarcinoma. Only one prior case report by Hoedl and colleagues in 2012 reports a case of a patient with concurrent autonomic neuropathy and PCD in one patient, but their underlying cancer was small cell lung cancer. 
Jennifer Amsdell, MD (Promedica Neuroscience Center)
Dr. Amsdell has nothing to disclose.
Mehmood Rashid, MD (Neuroscience Center) Dr. Rashid has nothing to disclose.