小細胞肺癌に抗CV2/CRMP5抗体を伴う傍骨性ミオパチーを呈した1例

[A case of paraneoplastic myelopathy associated with anti-CV2/CRMP5 antibodies with small-cell lung cancer].

• Chika Sato
• Takahiro Kano
• Ichiro Yabe
• Hidenao Sasaki

抄録

小細胞肺癌と抗レコベリン抗体を有する癌関連網膜症を合併した66歳女性が，肺癌の再発を伴う亜急性麻痺を呈した．脊髄MRIでは目に見える病変は認められなかったが，神経症状と脳脊髄液所見から骨髄炎を示唆した．抗CV2/CRMP5抗体も陽性であり，傍骨性骨髄症と診断された．プレドニゾロンによる投薬後、神経症状は改善し、神経症状の再発もなく3年以上生存していた。一般的に傍神経芽腫性ミオパチーは免疫療法に難治性であるが，この症例では免疫療法が奏功し，長期生存が可能となった。抗神経抗体の検査を行い、適切な免疫療法を選択して継続することをお勧めします。

A 66-year-old woman with small-cell lung cancer and cancer-associated retinopathy with anti-recoverin antibodies presented with subacute paraplegia associated with recurrence of lung cancer. Although a spinal cord MRI did not show any visible lesion, the neurological symptoms and cerebrospinal fluid findings indicated myelitis. Anti-CV2/CRMP5 antibodies were also positive and the patient was diagnosed with paraneoplastic myelopathy. After medication with prednisolone, her neurological symptoms improved and she survived over three years without recurrence of neurological symptoms. In general, paraneoplastic myelopathy is refractory against immunotherapy but in this case, immunotherapy was successful and resulted in long-term survival. We recommend examining anti-neuronal antibodies and choose and continue the appropriate immunotherapy.