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Images in Neurology
December 20, 2019

CRMP5-IgG–Associated Paraneoplastic Myelopathy With PD-L1 Inhibitor Therapy

Author Affiliations
  • 1Department of Neurology, Mayo Clinic, Rochester, Minnesota
  • 2Department Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
  • 3Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota
JAMA Neurol. 2020;77(2):255-256. doi:10.1001/jamaneurol.2019.4379

A 63-year-old woman presented with bilateral lower extremity weakness, Lhermitte sign, and urinary retention over a 3-week period. She had a 35–pack-year smoking history and was diagnosed as having stage IV small-cell lung cancer with lymphatic and liver metastases. She had been treated with 3 cycles of etoposide and carboplatin (3 daily doses per cycle) and atezolizumab (humanized monoclonal IgG1 antibody against programmed cell death ligand 1 [PDL1]; 1 dose per cycle).

Examination demonstrated bilateral finger extensor weakness, lower limb pyramidal weakness greater on the right side, bilateral Babinski signs, reduced vibration, joint position sense, and a midchest pin-prick sensory level. At the nadir, she required a wheelchair and self-catheterization.

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