title: Paraneoplastic cerebellar degeneration and lambert-eaton myasthenia in a patient with merkel cell carcinoma and voltage-gated calcium channel antibodies.
abstract: BACKGROUND
  Merkel cell carcinoma is a rare cutaneous, aggressive tumor. Although it shares many neuroendocrine features with small cell lung carcinoma, it has only occasionally been reported with paraneoplastic neurological syndromes.
  
  
  METHODS
  A healthy 67-year-old man developed acute ataxia, vertigo, and nausea. Subsequently he also developed dysarthria, diplopia, xerostomia, fatigability and progressive anorexia. He underwent a full diagnostic workup and was found to have a high titer of voltage-gated calcium channel antibodies in serum and cerebrospinal fluid, neurophysiological findings compatible with Lambert-Eaton myasthenia and neurological signs compatible with cerebellar degeneration.
  
  
  RESULTS
  A positron emission tomography study revealed a hypermetabolic lesion in the axilla, subsequently biopsied and consistent with Merkel cell carcinoma.
  
  
  CONCLUSIONS
  In most previous reports, neurological symptoms preceded the Merkel cell carcinoma diagnosis, and the primary localization was in lymph nodes. This tumor should be considered in patients with paraneoplastic syndrome, and particularly Lambert-Eaton myasthenia after exclusion of small cell lung carcinoma. Muscle Nerve 56: 998-1000, 2017.
authors.affiliation: Department of Biomedical and Neuromotor Sciences (DiBiNeM), University of Bologna, Via Altura 3, 40139, Bologna, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Pavolucci
authors.affiliation: Department of Biomedical and Neuromotor Sciences (DiBiNeM), University of Bologna, Via Altura 3, 40139, Bologna, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Giannini
authors.affiliation: Department of Biomedical and Neuromotor Sciences (DiBiNeM), University of Bologna, Via Altura 3, 40139, Bologna, Italy.|Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.
authors.forename: Maria Pia
authors.initials: MP
authors.lastname: Giannoccaro
authors.affiliation: Department of Biomedical and Neuromotor Sciences (DiBiNeM), University of Bologna, Via Altura 3, 40139, Bologna, Italy.
authors.forename: Maria Pia
authors.initials: MP
authors.lastname: Foschini
authors.affiliation: Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.
authors.forename: Bethan
authors.initials: B
authors.lastname: Lang
authors.affiliation: Department of Biomedical and Neuromotor Sciences (DiBiNeM), University of Bologna, Via Altura 3, 40139, Bologna, Italy.|IRCCS Institute of Neurological Sciences, Bologna, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Avoni
authors.affiliation: Department of Biomedical and Neuromotor Sciences (DiBiNeM), University of Bologna, Via Altura 3, 40139, Bologna, Italy.|IRCCS Institute of Neurological Sciences, Bologna, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Tinuper
authors.affiliation: Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.
authors.forename: Angela
authors.initials: A
authors.lastname: Vincent
authors.affiliation: Department of Biomedical and Neuromotor Sciences (DiBiNeM), University of Bologna, Via Altura 3, 40139, Bologna, Italy.|IRCCS Institute of Neurological Sciences, Bologna, Italy.
authors.forename: Rocco
authors.initials: R
authors.lastname: Liguori
mesh_terms: D000368:Aged; D001323:Autoantibodies / Q000097:blood*; D020864:Calcium Channels, N-Type / Q000276:immunology*; D015266:Carcinoma, Merkel Cell / Q000097:blood / Q000150:complications / Q000276:immunology; D006801:Humans; D015624:Lambert-Eaton Myasthenic Syndrome; D008175:Lung Neoplasms / Q000097:blood / Q000150:complications / Q000276:immunology; D008297:Male; D020362:Paraneoplastic Cerebellar Degeneration / Q000097:blood / Q000150:complications
chemical_list: D001323:Autoantibodies; D020864:Calcium Channels, N-Type
keywords: Lambert-Eaton myasthenia; Merkel cell carcinoma; cerebellar degeneration; neuroendocrine neoplasm; paraneoplastic syndrome; voltage-gated calcium channel antibodies