Case Report
Orthostatic hypotension secondary to CRMP-5 paraneoplastic autonomic neuropathy

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Abstract

The collapsin response mediator protein 5 (CRMP-5) autoantibody is one of only several paraneoplastic antibodies associated with autonomic neuropathy. Such paraneoplastic neuropathies manifest with a constellation of autonomic abnormalities. We present a unique case of orthostatic hypotension as the sole feature of a CRMP-5 paraneoplastic autonomic neuropathy in a patient with small cell lung cancer. Given the poor prognosis of paraneoplastic autonomic dysfunction, it is important to accurately diagnose the cause of orthostatic hypotension occurring on a background of malignancy.

Introduction

Paraneoplastic neuropathies are caused by mechanisms not related to metastases, metabolic disturbance, infections, coagulopathy or side-effects of cancer treatment. Autonomic neuropathy is characterised by subacute features including gastrointestinal pseudo-obstruction, bladder dysfunction, impotence, pupillomotor dysfunction and orthostatic hypotension [1].

The collapsin response mediator protein 5 (CRMP-5) autoantibody is predominantly associated with small cell lung cancers (SCLC) and thymoma. It is one of only a few paraneoplastic antibodies associated with autonomic neuropathy [2], [3], [4].

Such neuropathies generally present with a constellation of autonomic abnormalities. To our knowledge orthostatic hypotension has not been described as the sole feature of a paraneoplastic neuropathy.

Section snippets

Case report

A 66-year-old man was admitted under our oncology/palliative care unit with postural dizziness causing recurrent conscious collapse. He had a history of SCLC diagnosed 2 years prior, at limited stage, and treated with radical chemoradiotherapy including four cycles of cisplatin and etoposide (cumulative doses 1800 mg and 2640 mg, respectively). His medical history was also significant for an ex-smoking history of 30 pack-years.

Six weeks prior to this admission, he was found to have recurrent

Discussion

We present a patient who fulfils the criteria for a definite paraneoplastic syndrome, defined as, “a non-classical syndrome with onconeural antibodies and cancer that develops within 5 years of the diagnosis of the neurological disorder” [5].

A paraneoplastic aetiology is supported in this case by the subacute onset of symptoms, the presence of CRMP-5 antibodies which have a strong association with autonomic neuropathy [2], the strongly positive titre, and the exclusion of other likely causes.

Conflicts of interest/disclosures

The authors declare that they have no financial or other conflicts of interest in relation to this research and its publication.

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