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Título

CASE REPORT: AN ISOLATED PROGRESSIVE PARANEOPLASTIC MYELOPATHY ASSOCIATED WITH PRIMARY KIDNEY NEOPLASMS

RESUMO

Case presentation: Patient R.R.S, 70 years old, male, started in August 2021 with clinical symptoms of monoparesis in the distal region of the right lower limb. The initial condition of distal paraparesis evolved, in a period of 3 months, ascending to proximal involvement of the lower limbs - being unable to walk in November 2021. In January 2022 it evolved with urinary and fecal incontinence, being indicated by the Urology team indwelling urinary catheter. No history of spinal cord trauma was reported. In his past pathological history, he has a history of vaccination for COVID19 (Astrazeneca) in May 2021, Benign Prostatic Hyperplasia, Pulmonary Tuberculosis at age 20. During the reported period was made diagnostic investigation with third parties, not being defined the etiology. Neurological examination revealed a spinal cord syndrome, due to spastic paraplegia associated with hypoesthesia and crural apalesthesia up to T8 level. Admitted for diagnostic investigation, Neuroaxis Magnetic Resonance (MRI) was performed – an area of signal alteration in the central aspect of the spinal cord of D5-11 was evidenced, apparently without associated expansive effect, compatible with longitudinally extensive myelitis. In addition, Cerebrospinal Fluid was collected and analysis performed (including TRM-TB) – with no changes. Request complementary imaging exams, being evidenced in abdominal magnetic resonance imaging solid heterogeneous lesions in the right kidney, with a suspicious appearance for neoplastic involvement. On contrast-enhanced MRI of the skull, nodular lesions suggestive of secondary implants were visualized. Discussion: Due to the clinical picture reported and the imaging tests analyzed, the diagnostic hypothesis was of isolated progressive paraneoplastic myelopathy – with kidney neoplasia being the third most common etiology. As a change in this pathology, they were present in the reported patient T2-weighted signal hyperintensity, with involvement that extends to more than three vertebral segments - associated with a picture of progressive myopathy and evidence of primary neoplasm, Graus criteria can be used during diagnostic investigation. Final comments: The isolated progressive paraneoplastic myelopathy still present as a very rare and poorly described, requiring further studies on the disease.

Palavras Chave

Paraneoplastic myelopathy; primary kidney neoplasms