Anti-CV2-Associated Paraneoplastic Hemichorea Secondary to Diffuse Large B-cell Lymphoma

• Published in: Canadian journal of neurological sciences 2019-07, Vol.46 (4), p.480-481
• Main Authors: Nevison, Stephanie, Rizek, Philippe
• Format: Article
• Language: English
• Subjects: Aged; Antibodies; Autoantibodies - blood; Autoantibodies - immunology; Autoantigens - immunology; Blood platelets; Cancer therapies; Chemotherapy; Chorea - immunology; Family medical history; Humans; Hydrolases - immunology; Letter to the Editor; Lung cancer; Lymphoma; Lymphoma, Large B-Cell, Diffuse - complications; Male; Microtubule-Associated Proteins - immunology; Movement disorders; Paraneoplastic Syndromes, Nervous System - immunology; Patients
• ISSN: 0317-1671; 2057-0155
• DOI: 10.1017/cjn.2019.38

Patients with paraneoplastic chorea associated with anti-CV2 antibodies present with characteristic movement patterns.1 This paraneoplastic syndrome is most often in association with small-cell lung cancer although there are cases of patients diagnosed with adenocarcinomas, and rarely non-Hodgkin’s lymphoma.1–3 We report paraneoplastic hemichorea in a 71-year-old man diagnosed with diffuse large B-cell lymphoma, a unique case given the rare association with this malignancy. A 71-year-old man with a past medical history of essential thrombocytosis (platelet count in the normal range with hydroxyurea), well-controlled type II diabetes mellitus (HbA1c of 6.6% and point of care glucose of 6.2 on the day of presentation) and hypertension, presented to the emergency department with new-onset left-sided movement abnormalities. Paraneoplastic chorea is a rare clinical entity, most often presenting in the context of small-cell lung cancer and various adenocarcinomas.1–3 There are only four reported cases of paraneoplastic chorea in patients with non-Hodgkin’s lymphoma.4 Patients often present sub-acutely, with chorea developing over a period of 3–6 months before the diagnosis of malignancy.1 The movement disorder may be focal to start, becoming generalised and symmetric in the majority of patients.3 The trunk, neck and limbs are most often involved with more severe movements in the hands and feet.1 Patients commonly present after the age of 70 and with other neurological symptoms such as vision loss and peripheral neuropathy but can have an isolated movement disorder.1,3 Head MRI is normal in the majority of cases and family history non-contributory.1,3 The presence of anti-CV2 (CRMP-5) antibodies in our patient provides evidence to support a diagnosis of paraneoplastic chorea.