Poster 230 Paraneoplastic Cranial Nerve Palsies as the Initial Presentation of Sarcomatoid Carcinoma of the Lung: A Case Report

Abstract

A 79-year-old man consulted his doctor because of dysarthria, dysphagia, blurred vision, pain in the left eye, and pruritus accompanying shooting pains in the left V2 dermatome distribution. After admission to the hospital, the patient's symptoms worsened to include bilateral lateral gaze palsy and ptosis. Non-contrast CT scan of the head, CT angiography of the head and neck, CT scan of the abdomen and pelvis, autoimmune panels, lumbar puncture, and infectious disease titers were all negative. There was a persistent absolute neutrophilia, polypharmacy resistant hypertension revealed to be caused by renal artery stenosis, an M-spike on SPEP determined to be MGUS, and a 6mm noncalcified pulmonary nodule on the posterior aspect of the right upper lobe accompanied by a 2.6cm carinal mass, which was then attributed to lymphadenopathy. The patient underwent seven rounds of plasmapheresis, which led to complete resolution of his cranial nerve symptoms by hospital day 24. 45 days later, the patient noticed the onset of similar progression of cranial nerve involvement, and was admitted again after presenting to the ED with the complaint of severe nausea and vomiting. Two weeks into his second hospital stay, he was treated with an additional five rounds of plasmapheresis, without considerable improvement. He was then transferred to a different hospital, where a PET scan was performed, revealing hypermetabolic right subcarinal lymphadenopathy and a hypermetabolic right upper lobe nodule. The nodule was biopsied and revealed to be sarcomatoid carcinoma. Setting: In-patient neurology wards.