Optic neuritis in lung adenocarcinoma: A challenging diagnosis

Respir Med Res. 2022 Nov:82:100966. doi: 10.1016/j.resmer.2022.100966. Epub 2022 Oct 17.

Abstract

Optic neuritis with CRMP-5 IgG is a paraneoplastic inflammation of the optic nerve associated with lung cancer, mostly small-cell lung cancer. We present the case of a patient with lung adenocarcinoma who developed progressive bilateral visual loss a few months after immune-chemotherapy with pembrolizumab and after Covid-19 vaccination. Positive CRMP-5 IgG were detected in blood sample and complete work-up - including brain MRI - did not show any progression. High dose systemic corticoids were administered with transient improving, followed by intravenous immunoglobulins, methotrexate and rituximab but despite negativization of CRMP-5 IgG, the patient had a progressive visual loss.

Keywords: CRMP-5; Non-small cell lung cancer; Optic neuritis; Paraneoplastic syndrome.

Publication types

  • Case Reports

MeSH terms

  • Adenocarcinoma of Lung* / complications
  • Adenocarcinoma of Lung* / diagnosis
  • COVID-19 Vaccines
  • COVID-19*
  • Humans
  • Hydrolases
  • Immunoglobulin G
  • Lung Neoplasms* / complications
  • Lung Neoplasms* / diagnosis
  • Microtubule-Associated Proteins
  • Nerve Tissue Proteins
  • Optic Neuritis* / complications
  • Optic Neuritis* / etiology

Substances

  • COVID-19 Vaccines
  • Microtubule-Associated Proteins
  • Nerve Tissue Proteins
  • Hydrolases
  • Immunoglobulin G