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28-04-2022 | Constipation | Original Article

Paraneoplastic autoimmune autonomic ganglionopathy as the first symptom of bladder cancer: a case report and review of literature

Authors: Carmen de Rojas Leal, José María Lage-Sánchez, Javier Pinel-Ríos, Olmo León Plaza, Omar Hamad-Cueto, Maria Teresa Dawid de Vera, Marc Stefan Dawid-Milner

Published in: Neurological Sciences | Issue 8/2022

Abstract

Background

Autoimmune autonomic ganglionopathy is a rare, immune-mediated disorder associated with anti-ganglionic α3-subunit nicotinic acetylcholine receptor (anti-α3gAChR) antibodies, which bind to acetylcholine receptor in autonomic ganglia (parasympathetic and sympathetic) leading to autonomic failure. This disorder is mostly associated with viral infections, but it can also be associated with systemic malignancies. Here, we report the case of a paraneoplastic autonomic ganglionopathy as the first symptom of bladder cancer.

Method

Case report.

Results

A 47-year-old man, without medical history of interest, stated to the emergency department for progressive blurry vision with eye and mouth dryness, constipation, and dizziness upon standing for the last 2 weeks. Orthostatic hypotension was demonstrated by a drop in 13.3 mmHg mean blood pressure (BP) from supine (100/60 mmHg) to 45° reclining sitting position (80/50 mmHg). Blood tests, chest X-ray, brain MRI, and electroneuronography were unremarkable. Electrochemical skin conductance was reduced. Serological examination was positive for anti-α3gAChR antibodies. A full-body CT scan revealed a bladder tumor, which was treated by transurethral bladder resection. The pathologic study demonstrated a low-grade non-muscle-invasive bladder urothelial carcinoma. After tumor resection, and treatment with intravenous immunoglobulins and corticoids, a gradually improvement was observed. Today, the patient remains asymptomatic.

Conclusion

Subacute panautonomic failure can be the first symptom for systemic malignancies. This case reports a paraneoplastic autonomic ganglionopathy as the first symptom of bladder cancer. This case highlights the importance of a systemic study to rule out the presence of cancer when autoimmune autonomic ganglionopathy is present.

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Title: Paraneoplastic autoimmune autonomic ganglionopathy as the first symptom of bladder cancer: a case report and review of literature
Authors: Carmen de Rojas Leal
José María Lage-Sánchez
Javier Pinel-Ríos
Olmo León Plaza
Omar Hamad-Cueto
Maria Teresa Dawid de Vera
Marc Stefan Dawid-Milner
Publication date: 28-04-2022
Publisher: Springer International Publishing
Keywords: Constipation
Hypotension
Constipation
Hypotension
Published in: Neurological Sciences / Issue 8/2022
Print ISSN: 1590-1874
Electronic ISSN: 1590-3478
DOI: https://doi.org/10.1007/s10072-022-06075-y

At a glance: The STEP trials

Springer Medicine

Paraneoplastic autoimmune autonomic ganglionopathy as the first symptom of bladder cancer: a case report and review of literature

Abstract

Background

Method

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Method

Results

Conclusion

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