Paraneoplastic motor neuron disease in a patient with sigmoid colon adenocarcinoma - a case report

Abstract

Background. Paraneoplastic neurological syndromes (PNS) are a rare and diverse group of disorders caused by immune-mediated effects of malignancies. Affecting less than 1% of all cancer patients, these syndromes often present diagnostic and therapeutic challenges. Motor Neuron Disease as a paraneoplastic condition is particularly uncommon, especially in association with gastrointestinal malignancies like sigmoid colon adenocarcinoma. Case report. A 62-year-old male with Type 2 Diabetes Mellitus (T2DM) presented with chronic diarrhea and a three-year history of progressive bilateral limb weakness. Initial symptoms were attributed to diabetic neuropathy, but the rapid progression and severity warranted further investigation. Neurological examination revealed hypotonia, muscle wasting, and absent reflexes in all four limbs. Diagnostic tests, including electromyography (EMG) and nerve conduction studies, confirmed motor sensory axonal neuropathy. Colonoscopy revealed a mass in the sigmoid colon, and biopsy confirmed adenocarcinoma. The patient was managed with surgical resection of the tumor, adjuvant chemotherapy, and immunomodulatory treatments, resulting in stabilization of neurological symptoms. Conclusions. This case highlights the importance of considering paraneoplastic syndromes in patients with unexplained neurological symptoms, particularly when a malignancy is suspected or known. Early recognition and a multidisciplinary approach are crucial for improving patient outcomes. Further research is needed to understand the pathophysiological mechanisms and develop sensitive biomarkers for early detection.

Keywords

• paraneoplastic neurological syndromes
• lower motor neuron disease
• sigmoid colon adenocarcinoma
• autoimmune response
• multidisciplinary approach
• early detection
• symptoms
• type 2 diabetes mellitus