Abstract
Background/Objectives Painful peripheral neuropathies are common.
However, particularly when they are accompanied by a particular malignancy, rarer paraneoplastic phenomena require consideration.
Methods A case is discussed in which a patient presented with painful peripheral neuropathy, fasciculations, and in the context of a recent abnormal computed tomography (CT) of the chest.
Results A 70-year-old male presented to hospital with painful paraesthesia in the feet that then spread up his legs over 4 weeks. He also had a cough and 5 kilograms of recent unintentional weight loss. Physical examination revealed widespread fasciculations, reduced sensation to pinprick and cold to the mid shin and distal forearms bilaterally. Prior to hospital presentation he had a CT chest with a lobulated anterior mediastinal mass. NCS demonstrated complex repetitive discharges and prominent myokymia. CASPR2-IgG was subsequently positive on serum. He was diagnosed with a thymoma (WHO B3), which was subsequently resected. His diagnosis was Morvan’s syndrome in the setting of a thymoma. He was treated with methylprednisolone, IVIg, and rituximab.
Conclusions/Discussion Paraneoplastic phenomena are a significant consideration for patients with peripheral painful paraesthesia. Prudent malignancy screening may reveal diagnoses such as Morvan’s syndrome. The role for malignancy screening in these populations is discussed.
