[Lambert-Eaton myasthenic syndrome with acute respiratory failure associated with small cell lung cancer].
METHODS
A 53-year-old woman had suffered from progressive lower limb weakness for 8 weeks. She was not able to walk on her own. Two hours after admission endotracheal intubation and mechanical ventilation became necessary because of acute respiratory failure.


METHODS
Chest radiograph and computerized tomography showed a huge lesion originating from the lower lobe of the left lung with mediastinal infiltration. Histological examination of bronchoscopical-guided biopsy disclosed small cell lung cancer. Electrophysiological studies revealed an incremental response on high-rate stimulation in the repetitive nerve stimulation test. Autoantibodies to P/C-type voltage-gated calcium channels were detected. Further, laboratory test results revealed hyponatremia (100 mmol/l) and elevated ADH (11 pg/ml).


METHODS
These results led to the diagnosis of paraneoplastic Lambert-Eaton myasthenic syndrome (LEMS) with acute respiratory failure caused by small cell lung cancer. Additionally, SIADH (syndrome of inappropriate antidiuretic hormone secretion) was diagnosed as another paraneoplastic disease. Because of a prolonged weaning process resulting from inadequacy of mechanical ventilation, administration of intravenous immunoglobulins and chemotherapy with cisplatin and etoposide were undertaken. This made successful extubation possible after 7 days. In spite of all supportive treatment, clinical deterioration occurred. The patient died 27 days after the small cell lung cancer had been diagnosed.


CONCLUSIONS
The Lambert-Eaton myasthenic syndrome should be considered in cases of unexplained acute respiratory failure and clinical evidence of neoplastic disease.
Brueck
M
M
Medizinische Klinik I, Klinikum Wetzlar-Braunfels, Germany. Martin.Brueck@hkw.med.uni-giessen.de
Vogel
S
S
Waeger
S
S
Braig
G
G
Kramer
W
W
D000208:Acute Disease; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001706:Biopsy; D001999:Bronchoscopy; D018288:Carcinoma, Small Cell / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D002945:Cisplatin / Q000008:administration & dosage; D003937:Diagnosis, Differential; D004576:Electromyography; D005047:Etoposide / Q000008:administration & dosage; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007116:Immunization, Passive; D007177:Inappropriate ADH Syndrome / Q000175:diagnosis / Q000473:pathology; D015624:Lambert-Eaton Myasthenic Syndrome / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D008168:Lung / Q000473:pathology; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D008875:Middle Aged; D009460:Neurologic Examination; D010166:Palliative Care; D012131:Respiratory Insufficiency / Q000175:diagnosis* / Q000473:pathology; D014057:Tomography, X-Ray Computed
D005047:Etoposide; D002945:Cisplatin