Atypical Dysphagia in an Anti-Hu Positive Non-Small-Cell Lung Cancer Patient / 대한연하장애학회지

Anti-Hu antibodies usually present in small cell lung cancer are associated with encephalomyelitis, encephalitis, cerebellitis, and neuropathies. However, to our knowledge, non-small-cell lung cancer (NSCLC) related anti-Hu syndrome presenting acute exacerbation of dysphagia has not been reported. Herein, we report a rare case of atypical dysphagia in an anti-Hu positive NSCLC patient resulting in a fatal outcome. A 73-year-old Korean male went through surgical interventions for recurrent tongue cancer and NSCLC. After the surgery, he resumed full oral feeding with a regular diet. However, four weeks later, he developed a sudden difficulty in swallowing. Neck computed tomography angiography, brain magnetic resonance imaging, brain positron emission tomography, computed tomography and electromyography all showed nonspecific findings. A paraneoplastic antibody test was positive for anti-Hu antibodies. His dysphagia worsened and eventually, he expired due to malignant pleural effusion. Our case shows that anti-Hu antibodies can be expressed in NSCLC and when associated with dysphagia, the outcome can be fatal.

Dysgeusia as Anti-GQ1b Antibody Syndrome with Brainstem Involvement: A Tractography Case Report / 대한연하장애학회지

Dysgeusia and dysphagia are rarely reported as the sole clinical symptoms of anti-GQ1b antibody syndrome involving the cranial nerves (CN). According to previous reports, those exhibiting bilateral facial nerve palsy or ophthalmoplegia or both are followed by bulbar dysfunctions (CNs IX and X). This paper reports a case of a 22-year-old man showing dysgeusia with dysphagia and mild limb weakness. Fiberoptic endoscopy revealed signs of residues after swallowing. The nerve conduction study (NCS) in the limbs and conventional brain magnetic resonance imaging were normal. Further workup revealed a positive serum anti-GQ1b antibody. The diffusion tension weighted brain images with tractography revealed involvement to the bilateral corticobulbar and corticospinal tract at the brainstem level. Although his normal NCS and conventional brain MRI made the diagnosis difficult, it was confirmed to be a rare variant of anti-GQ1b antibody syndrome showing corticobulbar and corticospinal tract involvement. The patient showed excellent recovery after dysphagia treatment.