Occam's Razor or Hickam's Dictum: A Paraneoplastic or Coincidental Occurrence of Lung Cancer and Guillain-Barré Syndrome

Abstract

A 67-year-old man was admitted due to weakness, coughing, shortness of breath and fever. He had decreased breath sounds in the left lung and muscle weakness in the lower and upper extremities. Chest imaging showed a mass in the left lung, and a biopsy revealed small cell lung cancer. The nerve conduction velocity was decreased, and anti-GM1 IgG antibodies were positive. The patient showed a temporary neurologic recovery following the administration of cancer chemotherapy, although he eventually died of progression of lung cancer. As a result of the almost simultaneous symptomatic development of lung cancer and Guillain-Barré syndrome, this case may be considered to involve a paraneoplastic neurologic syndrome.

Paraneoplastic Guillain-Barré Syndrome in Small Cell Lung Cancer

“…This case is different from the existing 6 cases. In the present case, GBS occurred in a patient receiving long-term antineoplastic therapy, whereas GBS had occurred at the initial point of presentation in the 6 other cases [ 2 , 3 , 4 , 5 , 6 , 7 ]. This is the first reported case of paraneoplastic GBS that developed in an SCLC patient with long-term therapy.…”

“…In 4 of the 5 reports, patients received chemotherapy; however, in all 4 of these reports, the patients underwent chemotherapy after GBS had been diagnosed and IVIg had been given. In addition, in 3 of these 4 reports, a combination of etoposide and carboplatin was used, whereas the other report did not indicate the chemotherapy regimen [ 2 , 3 , 4 , 5 , 6 ].…”

“…There have been reports of paraneoplastic GBS in different cancers. To the best of the present authors’ knowledge, there are 6 published reports of GBS in SCLC [ 2 , 3 , 4 , 5 , 6 , 7 ]. Here, we report a case of a 52-year-old man who was diagnosed with GBS in SCLC with chemotherapy.…”

A Coin-Like Peripheral Small Cell Lung Carcinoma Associated with Acute Paraneoplastic Axonal Guillain-Barre-Like Syndrome

“…Regarding paraneoplastic Guillain-Barre syndrome, this has been reported in fewer than 80 PubMed-cited papers as the first clinical presentation of less than 1% of malignant tumors. 4 , 8 , 11 The first report in the field was published by Rohmer et al (1962) 12 in a patient with solitary myeloma. Up until then, this syndrome had been noted as the first clinical sign in patients with Hodgkin lymphomas and carcinomas, independently of their location or histologic type and in most cases having a subacute evolution.…”

Clinical Reasoning: Stepwise paralysis in a patient with adenocarcinoma of lung

“…9,[11][12][13][14] While coincidental occurrence of postinfectious AIDP and lung cancer is possible, the search for a paraneoplastic cause or drug side effect seems more appealing because "plurality must not be posited without necessity" (Occam's razor). 15 In a recent publication, a patient with adenocarcinoma of lung developed AIDP that was attributed to CASPR2 antibodies. 13 Our patient tested negative for voltage-gated potassium channel antibodies (i.e., anti-CASPR2 and anti-LGI1) and anti-Hu antibodies, which are more commonly seen in patients with paraneoplastic peripheral neuropathy due to lung cancer.…”