Optic neuritis in lung adenocarcinoma: A challenging diagnosis

• DOI: 10.1016/j.resmer.2022.100966
• Publication Date: 2022-10-17T07:45:48Z
• Authors: Anouk Goudsmit; Mariana Brandao; Ali Oullai; Dan Engelman; Nathalie Ghorra; Tarik Daif; Tom Buelens; Anne-Pascale Meert
• Keywords: COVID-19 Vaccines; Optic Neuritis; Lung Neoplasms; Hydrolases; COVID-19; Nerve Tissue Proteins; Adenocarcinoma of Lung; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Immunoglobulin G; Humans; Microtubule-Associated Proteins

Optic neuritis with CRMP-5 IgG is a paraneoplastic inflammation of the optic nerve associated with lung cancer, mostly small-cell lung cancer. We present the case of a patient with lung adenocarcinoma who developed progressive bilateral visual loss a few months after immune-chemotherapy with pembrolizumab and after Covid-19 vaccination. Positive CRMP-5 IgG were detected in blood sample and complete work-up - including brain MRI - did not show any progression. High dose systemic corticoids were administered with transient improving, followed by intravenous immunoglobulins, methotrexate and rituximab but despite negativization of CRMP-5 IgG, the patient had a progressive visual loss.