Bilateral Paraneoplasic Optic Neuropathy and Retinopathy Revealing Lung Small Cell Carcinoma

Abstract

Abstract: : Purpose: To describe a patient with bilateral optic neuropathy and retinopathy revealing small-cell lung carcinoma with 12 month follow-up and to present review of the literature regarding electrophysiological findings.Methods: Prospective case report and review of the literature. Results: A 53-year-old man presented with a history of photophobia and unilateral visual loss for one month prior to presentation. Ophthalmologic examination demonstrated visual acuity of 20/60 OD, 20/20 OS, normal ocular motility, bilateral optic disc oedema without maculopathy on fundus examination and fluorescent angiography. Visual field showed bilateral enlarged blind spot. Electroretinogram (ISCEV) revealed both cone and rod system abnormality on both eyes but worth on cone system on OD. Visual evoked potential showed bilateral marked delay in P wave latency. Neurological examination and cerebral MRI were normal. CSF examination showed high protein level with normal cell count and opening pressure. A work-up including lung CT scan and biopsy demonstrated small-cell lung carcinoma. Blood test was normal. The patient underwent intravenous chemotherapy followed by radiotherapy. On further follow-up, at 12 month, visual acuity was 20/20 OU with normal fundus examination but persistent photophobia and electrophysiological abnormalities. Conclusions: Paraneoplasic visual syndromes are rare and association of bilateral optic neuropathy and retinopathy has not been previously described. Possible mechanisms are immunological but correlation has yet to be defined.

Keywords: CAR • electrophysiology: clinical • optic disc