What happened, in summary

A 56-year-old man sought care after 3 months of vomiting, early fullness, abdominal discomfort, constipation and a 55-pound weight loss. He also had slurred speech, an unsteady gait and orthostatic hypotension. His history included a 30 pack-year smoking history.

Because his symptoms raised concern for an underlying cancer-related neurologic syndrome, blood testing included a paraneoplastic antibody panel. ANNA-1 was strongly positive at 1:61,440, and neuronal acetylcholine receptor antibody measured 0.05 nmol/L, above the reference range of less than 0.02 nmol/L. A PET scan performed 1 month after a negative chest CT then showed hypermetabolic activity in the mediastinum, with a maximum standardized uptake value of 7.1.

Bronchoscopy with endobronchial ultrasound and needle sampling of a left paratracheal lesion confirmed small cell carcinoma of the lung. The cancer was described as limited-stage small cell lung cancer.

He started chemotherapy with carboplatin and etoposide together with thoracic radiation therapy. His speech and strength improved during treatment. Repeat PET/CT imaging 4 months after the initial assessment showed no recurrent or metastatic lung cancer. His presentation linked the lung cancer with a paraneoplastic syndrome that caused prominent digestive, autonomic and neurologic symptoms.