Bilateral tonic pupils with evidence of anti-hu antibodies as a paraneoplastic manifestation of small cell lung cancer.
BACKGROUND
Ophthalmological manifestations of systemic malignancies can be either direct, metastatic or paraneoplastic. The latter are remote effects of carcinoma, often caused by autoantibodies. Ophthalmological manifestations include cancer-associated retinopathy, melanoma-associated retinopathy, opsoclonus-myoclonus syndrome or motility disorders due to effects on the neurological system. A unilateral tonic pupil is usually a benign finding but has also been described in the context of paraneoplastic syndromes, in some cases associated with anti-Hu antibodies.


METHODS
The authors describe 2 patients with bilateral symptomatic tonic pupils due to a paraneoplastic syndrome. Both patients had been treated for small cell lung cancer and had evidence of anti-Hu antibodies (autoantibodies against nuclei of neural cells) in serum and cerebrospinal fluid. Both had typical pupillary findings and hypersensitivity to diluted pilocarpine. The first patient also had sensory neuronopathy, the second affection of several cranial nerves.


CONCLUSIONS
To the best of our knowledge, to date no case of bilateral tonic pupils has been published due to a paraneoplastic disorder with evidence of autoantibodies. This is surprising, as it is probable that autoantibodies in paraneoplastic disorders affect both ciliary ganglions in a similar way.
Department of Paediatric Ophthalmology, Strabismology and Ophthalmogenetics, University of Regensburg, Regensburg, Germany. bettina.wabbels@klinik.uni-regensburg.de
Bettina K
BK
Wabbels
Heike
H
Elflein
Birgit
B
Lorenz
Gerold
G
Kolling
D000368:Aged; D001323:Autoantibodies / Q000097:blood*; D018288:Carcinoma, Small Cell / Q000150:complications* / Q000473:pathology / Q000628:therapy; D003131:Combined Modality Therapy; D051959:ELAV Proteins; D005260:Female; D019084:Fluorescent Antibody Technique, Indirect; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications* / Q000473:pathology / Q000628:therapy; D008875:Middle Aged; D009419:Nerve Tissue Proteins / Q000276:immunology*; D010257:Paraneoplastic Syndromes / Q000150:complications* / Q000473:pathology; D016601:RNA-Binding Proteins / Q000276:immunology*; D015845:Tonic Pupil / Q000209:etiology* / Q000276:immunology
D001323:Autoantibodies; D051959:ELAV Proteins; D009419:Nerve Tissue Proteins; D016601:RNA-Binding Proteins