title: Demyelinating neuropathy with anti-CRMP5 antibodies predating diagnosis of breast carcinoma: favorable outcome after cancer therapy.
abstract: BACKGROUND
  Breast cancer is exceptionally associated with anti-collapsin response mediator protein 5 (anti-CRMP5) antibody or demyelinating neuropathy. This paraneoplastic antibody is itself not associated with demyelinating neuropathy.
  
  
  METHODS
  Herein we describe a patient with a predominantly sensory ataxic demyelinating neuropathy associated with an IgG-kappa monoclonal gammopathy of uncertain significance (MGUS). Further investigations led to identification of anti-CRMP5 antibodies. An initial search for a malignancy proved negative. No immunomodulatory therapy was administered.
  
  
  RESULTS
  The patient developed breast carcinoma 2 years after the initial neurological symptoms, which was effectively treated by surgery, chemotherapy, hormone therapy, and radiotherapy. At neurological follow-up, 16 months after cancer treatment, she remained in remission and had made substantial neurological recovery. Electrophysiology showed significant amelioration, and serum anti-CRMP5 antibodies were undetectable. MGUS paraprotein level was unchanged.
  
  
  CONCLUSIONS
  This case widens the range of paraneoplastic manifestations of breast carcinoma to include anti-CRMP5 antibody-positive sensory ataxic demyelinating neuropathy, which, in this patient, improved after cancer treatment.
authors.affiliation: Neuromuscular Clinic, Department of Neurology, University Hospitals of Leicester, Leicester LE5 4PW, UK.
authors.forename: Shanika
authors.initials: S
authors.lastname: Samarasekera
authors.forename: Yusuf A
authors.initials: YA
authors.lastname: Rajabally
mesh_terms: D000368:Aged; D001323:Autoantibodies / Q000096:biosynthesis*; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000276:immunology / Q000628:therapy*; D002277:Carcinoma / Q000175:diagnosis / Q000276:immunology / Q000628:therapy*; D003711:Demyelinating Diseases / Q000175:diagnosis* / Q000276:immunology / Q000628:therapy; D005260:Female; D006801:Humans; D006867:Hydrolases; D008869:Microtubule-Associated Proteins; D009419:Nerve Tissue Proteins / Q000276:immunology*; D011115:Polyneuropathies / Q000175:diagnosis* / Q000276:immunology / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D001323:Autoantibodies; D008869:Microtubule-Associated Proteins; D009419:Nerve Tissue Proteins; C415087:DPYSL5 protein, human; D006867:Hydrolases