A 64-year-old man complained of progressive painless bilateral loss of vision that affected his left eye (LE) for 7 days and that in the last 48 hours he had also begun to affect his right eye.
The patient's history included being an important smoker and the death of a brother due to lung cancer.
In the exploration, we found a corrected visual acuity of 0.4 in the RE and hand movement in the LE.
Intraocular pressure and anterior segment were normal, observing moderate stenosis in both eyes, papilla hyperemia of the right eye, and mild papillary stenosis in the left eye.
It was decided to be admitted for study, with the initial diagnosis of bilateral papillitis with colitis.
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Neurological examination, blood count and biochemistry were normal.
A chest X-ray showed mild thickening of the right pulmonary hilium, with a normal cranial CAT scan.
Lumbar puncture showed only a slight elevation of proteins.
With these data it was decided to start treatment with corticosteroids bolus and antiplatelet therapy.
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Fluorescein angiography showed papillary hyperuptake with no signs of vasculitis.
Evoked potentials were normal in RE and compatible with an axonal neuropathy in OI.
Electroretinogram and magnetic resonance imaging were normal.
Serology, immunology and usual tumor markers were negative.
With the tests obtained, an infectious, vascular or demyelinating etiology was ruled out, for which a etiology was assessed, or a paraneoplastic syndrome.
An abdominal CT was requested, which showed a 3 cm image in the right hilium, compatible with adenopathy.
Bronchoscopy reported a carina widening, and cytology was negative for malignancy.
A PET study was performed to better assess adenopathy and refer the patient to thoracic surgery for mediastinoscopy.
In addition, samples of cerebrospinal fluid, plasma and aqueous humor were extracted to study the autoantibodies CRMP-5-IgG, which was positive in the first two.
The positivity to CRMP-5-IgG and the presence of neuritis was associated in 62.5% of cases with the existence of a microcytic lung carcinoma (2.3).
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With these data it was decided to annul the PET study and perform mediastinoscopy, which was reported as a microcytic lung carcinoma.
Ongoing treatment with chemotherapy and radiotherapy was classified as microcytic carcinoma in a limited stage.
The initial response to corticoid treatment was good, improving vision to 0.7-0.3 at 15 days and achieving a final visual acuity at six months, when we consider the study closed, 0.8 in OD image and 0.6 in OD funduscopic.
