Dysdiadochokinesia, Ataxia, and Anemia: A Sign of Intraluminal Malignant Mesothelioma?

Our plain-English summary of Dysdiadochokinesia, Ataxia, and Anemia: A Sign of Intraluminal Malignant Mesothelioma?, by R. Rozner, S.L. Shah, K. Chiu, et al (ACG Case Reports Journal, 2021).

The study

• Authors: R. Rozner, S.L. Shah, K. Chiu, C.V. Crawford
• Journal: ACG Case Reports Journal
• Published: 2021;8(4):e00560
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

An 87-year-old man presented with altered mental status and ataxia was found to have a neuron-restricted antibody in his cerebrospinal fluid, concerning for a paraneoplastic syndrome of unknown origin. He also exhibited anemia, but otherwise normal electrolytes and liver chemistries. He underwent positron emission tomography/computed tomography which revealed abdominal lymphenopathy. He then underwent push enteroscopy and was found to have a jejunal mass, biopsy proven to be malignant mesothelioma. Malignant mesothelioma is 4-5 times more prevalent in men than women. It is limited to the small bowel, and paraneoplastic syndromes are extremely rare and carry a poor prognosis. The presence of anemia with cerebellar symptoms should trigger a search for a paraneoplastic syndrome-related malignancy.

© 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology.

In plain English

This case report described one patient: an 87-year-old man with several months of unintentional weight loss, unsteady walking, and trouble performing rapid, alternating movements (dysdiadochokinesia). His cerebrospinal fluid tested positive for a neuron-restricted autoantibody. This raised concern for a paraneoplastic neurologic syndrome, a nervous-system disorder linked to a hidden cancer. Intravenous immunoglobulin and prednisone brought minimal improvement. He was anemic, with a hemoglobin of 9.8 g/dL. A PET/CT scan showed active abdominal and mesenteric lymph nodes, one inseparable from the small bowel. Push enteroscopy found a large, oozing, ulcerated mass in the jejunum, and biopsy staining supported a diagnosis of mesothelioma. The authors attributed his neurologic decline to the paraneoplastic syndrome, secondary to peritoneal mesothelioma. He was also found to have prostate cancer and was later lost to follow-up. The report gave no history of asbestos exposure for this patient. The authors concluded that anemia with cerebellar symptoms should prompt a search for a related cancer, including rare forms such as peritoneal mesothelioma.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: one 87-year-old man with a family history of colon cancer in one first-degree relative; the report does not state the place or dates of care
• Main results:
  • The patient's cerebrospinal fluid was positive for a neuron-restricted autoantibody, raising concern for a paraneoplastic neurologic syndrome
  • He was treated with 5 days of intravenous immunoglobulin and 3 days of oral prednisone 60 mg daily, with minimal improvement
  • In this patient: elevated prostate-specific antigen of 9.0 ng/mL and decreased hemoglobin of 9.8 g/dL
  • Push enteroscopy found a large, oozing, ulcerated mass in the proximal jejunum, which was biopsied
  • The tumor stained strongly and diffusely positive for cytokeratin, CK7, WT-1 and calretinin, results the authors said supported a diagnosis of mesothelioma
  • The patient's neurologic decline was attributed to a paraneoplastic neurologic syndrome secondary to peritoneal mesothelioma
  • The patient was also found to have prostate cancer
  • The patient was discharged with plans for chemotherapy or hospice and was lost to follow-up
• The authors' conclusion: The authors concluded that, although exceedingly rare, anemia with cerebellar symptoms such as dysdiadochokinesia should trigger a search for a paraneoplastic-syndrome-related cancer, including rare forms such as peritoneal mesothelioma

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Biopsy, Prognosis.

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