Burg Ethan, Sharbin Gabrielle, Edeson Max E, Hosseini Hanieh K, Westman Colin, Hosseini Davood K, Patel Shil, Weinberger Jonathan D, Zhu Hongfa, Ligresti Rosario
Hackensack Meridian School of Medicine, Nutley, NJ.
Thomas J. Long School of Pharmacy, Stockton, CA.
Medicine (Baltimore). 2025 May 23;104(21):e42133. doi: 10.1097/MD.0000000000042133.
Transverse myelitis (TM) is a non-compressive myelopathy caused by spinal cord inflammation that can present with motor, sensory and autonomic deficits. Paraneoplastic TM represents a rare etiology of TM caused by autoantibodies targeting the spinal cord in the setting of malignancy, most frequently lung cancers and lymphoproliferative disorders. Anti-glutamic acid decarboxylase 65 (GAD65) is a rare antibody associated with paraneoplastic neurological sequelae. This case presents a GAD65 positive paraneoplastic TM in the setting of a pancreatic tail adenocarcinoma.
A 51-year-old male with an 18.5 pack year smoking history presented for 4 months of progressively worsening left-sided weakness and back pain. He endorsed numbness, tremors and paresthesias of his left upper extremity, left lower extremity weakness with unsteady gait.
Magnetic resonance imaging demonstrated C4-T1 demyelination consistent with TM. The serum paraneoplastic panel revealed a positive GAD65 prompting further workup for occult malignancy. Computed tomography chest abdomen and pelvis and magnetic resonance imaging with magnetic resonance cholangiopancreatography showed pancreatic body and tail enlargement. A pancreatic tail mass was confirmed on endoscopic ultrasound. Pathology was consistent with pancreatic ductal adenocarcinoma, confirming the diagnosis of a paraneoplastic TM.
He received 5 days of methylprednisolone (1.0 g daily) and plasmapheresis for initial treatment of his TM and 5 days of methylprednisolone for his repeat episode. He was being treated for stage III T4N1 pancreatic cancer. He had completed 2 cycles of oxaliplatin, irinotecan, leucovorin, and 5-flurouracil (mFOLFIRINOX).
The patient initially had improvement in his neurological symptoms following the first chemotherapy cycle but developed quadriparesis requiring readmission for subacute TM. He transitioned to hospice care given progression of malignancy.
This case highlights the importance of GAD65 as a paraneoplastic antibody and promotes awareness of pancreatic tail adenocarcinoma as a rare cause of paraneoplastic TM.
横贯性脊髓炎（TM）是一种由脊髓炎症引起的非压迫性脊髓病，可表现为运动、感觉和自主神经功能障碍。副肿瘤性TM是TM的一种罕见病因，由针对脊髓的自身抗体在恶性肿瘤（最常见的是肺癌和淋巴增殖性疾病）背景下引起。抗谷氨酸脱羧酶65（GAD65）是一种与副肿瘤性神经后遗症相关的罕见抗体。本病例报告了一例在胰尾腺癌背景下的GAD65阳性副肿瘤性TM。
一名有18.5年吸烟史的51岁男性，因进行性加重的左侧肢体无力和背痛4个月前来就诊。他自述左上肢麻木、震颤和感觉异常，左下肢无力且步态不稳。
磁共振成像显示C4 - T1节段脱髓鞘，符合TM表现。血清副肿瘤抗体检测显示GAD65阳性，促使进一步检查隐匿性恶性肿瘤。胸部、腹部和骨盆的计算机断层扫描以及磁共振胰胆管造影的磁共振成像显示胰体和胰尾增大。内镜超声检查证实胰尾有肿块。病理检查结果与胰腺导管腺癌一致，确诊为副肿瘤性TM。
他接受了5天的甲泼尼龙（每日1.0 g）和血浆置换用于TM的初始治疗，复发时又接受了5天的甲泼尼龙治疗。他正在接受III期T4N1胰腺癌的治疗。他已经完成了2个周期的奥沙利铂、伊立替康、亚叶酸钙和5 - 氟尿嘧啶（mFOLFIRINOX）化疗。
患者在第一个化疗周期后最初神经症状有所改善，但随后发展为四肢瘫，因亚急性TM再次入院。鉴于恶性肿瘤进展，他转至临终关怀护理。
本病例强调了GAD65作为副肿瘤抗体的重要性，并提高了对胰尾腺癌作为副肿瘤性TM罕见病因的认识。
