Muhammad B. Hammami, MD, Reem Aboushaar, MS, Mishah Azhar, MD, Ahmad Musmar, MD, Stephen M. Miller, MD, FACG, Peter Salomon, MD, FACG
Florida Atlantic University, Boca Raton, FL
Introduction: Dancing eye or opsoclonus-myoclonus syndrome is a rare paraneoplastic syndrome that has been mostly associated with small cell lung cancer. It was reported in association with esophageal cancer in one case. Here we report a second case.
Case Description/Methods: A 59-year-old man presented with 5 weeks of rapidly worsening vertigo and gait difficulty that lead to frequent falls and inability to perform daily activities. About 5 weeks prior to presentation, he completed three rounds of cisplatin and 5-FU for recently diagnosed squamous cell carcinoma of the esophagus. He had long standing hypertension treated with hydrochlorothiazide, lisinopril, and carvedilol, and diabetes mellitus treated with glipizide, glyxambi, and sitagliptin. He denied alcohol, tobacco, or illicit drug use and recent viral infection. He was fully alert and oriented and afebrile. He had spontaneous, involuntary, arrhythmic, conjugate, multidirectional saccades occurring in all directions of gaze without a saccadic interval and pronounced ataxia on standing associated with unsteadiness. Complete blood count and routine chemistry were unremarkable. Brain MRI with and without contrast revealed no evidence of intracranial hemorrhage, mass lesion, acute infarct or pathologic enhancement. HIV screen was negative. Hepatits C virus antibody was non-reactive. Paraneoplastic autoantibodies screening was negative. He received 5 day course of 0.4g/kg/day intravenous immunoglobulin (IVIG) and 250 mg BID methylprednisolone with marked improvement of rhythmic eye beating at rest, coordination of multidirectional eye movements, ataxia, and vertigo by day 3. He was discharged to acute rehabilitation facility on day 8.
Discussion: Our patient has dancing eye or opsoclonus-myoclonus syndrome that followed the diagnosis of esophageal cancer and rapidly responded to IVIG and methylprednisolone, strongly suggesting a paraneoplastic association. Interestingly and consistent with the single case previously reported of this association, paraneoplastic autoantibodies screen was negative.
Citation: Muhammad B. Hammami, MD, Reem Aboushaar, MS, Mishah Azhar, MD, Ahmad Musmar, MD, Stephen M. Miller, MD, FACG, Peter Salomon, MD, FACG. P0306 - ESOPHAGEAL SQUAMOUS CELL CARCINOMA-ASSOCIATED DANCING EYE SYNDROME IN AN ADULT: NEGATIVE PARANEOPLASTIC ANTIBODIES SCREEN AND RAPID RESPONSE TO INTRAVENOUS IMMUNOGLOBULIN AND METHYLPREDNISOLONE. Program No. P0306. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.