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- W2977304927 abstract "A 33 year-old woman with history of chronic constipation, endometriosis, prior hysterectomy and oophorectomy, and 20 pack-year smoking history presented to the hospital with a chief complaint of obstipation for two weeks. She endorsed nausea, a 20-pound weight loss over two months, ataxia, diplopia, and left sided hearing loss. She reported constipation for 13 years, and neurologic symptoms for 6 years. Physical exam revealed cachexia with a BMI of 13. Her blood chemistry, CBC, and LFTs were normal, with deficiencies of vitamins B1, B6, and D. Abdominal CT scan showed a dilated, stool filled colon compressing the stomach and dilated esophagus (Figure 1 and 2). She had extensive evaluation at an outside hospital that found a positive anti-Hu antibody at a titer of 1:30720 (normal < 1:240). She received IVIG without improvement and was lost to follow-up. No malignancy was found during this evaluation. EGD showed extrinsic narrowing of the esophagus, which was attributed to extreme distension of the colon, and EUS showed a dilated esophagus without evidence of malignancy. Small bowel follow-through showed smooth tapering of the distal esophagus without contrast passing into the stomach. Esophageal manometry was consistent with type I achalasia (Figure 3). Repeat paraneoplastic panel was positive for anti-Hu antibody with titer of 1:1920, consistent with paraneoplastic gastrointestinal dysmotility (PGID). After failing to achieve relief with an oral and rectal bowel regimen, she was started on IV methylprednisolone, and was discharged on oral prednisone and weekly methotrexate. She was discharged on nasojejunal tube feeds.Figure 1Figure 2Figure 3PGID can present with isolated syndromes including achalasia, gastroparesis, chronic intestinal pseudoobstruction, slow transit constipation, and pelvic floor dyssynergia, or can involve multiple organs, as in this case. PGID is frequently associated with malignancy, most frequently small cell lung cancer (SCLC); symptoms can preceded tumor diagnosis of SCLC by as many as 2 years.1 Anti-Hu is the most common antibody associated with PGID, which is believed to bind to Hu proteins on neurons leading to gastrointestinal and neurologic manifestations." @default.
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- W2977304927 date "2016-10-01" @default.
- W2977304927 modified "2023-10-14" @default.
- W2977304927 title "An Unusual Case of Paraneoplastic Gastrointestinal Dysmotility" @default.
- W2977304927 doi "https://doi.org/10.14309/00000434-201610001-02071" @default.
- W2977304927 hasPublicationYear "2016" @default.
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