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Paraneoplastic ophthalmoplegia and subacute motor axonal neuropathy associated with anti-GQ1b antibodies in a patient with malignant melanoma

¹ Department of Neurology, Erasmus University Medical Centre, Rotterdam, Netherlands
² Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Centre
³ Department of Medical Oncology, Erasmus University Medical Centre

Correspondence to:
Correspondence to:
Dr Peter Sillevis Smitt, Department of Neurology, Erasmus University Medical Centre, Dr Molewaterplein 40, 3015 GD Rotterdam, Netherlands;
sillevis{at}neuh.azr.nl

ABSTRACT
A 68 year old woman developed oculomotor paresis shortly after metastatic progression of her melanoma was discovered. She was then immunised with the tumour antigen MAGE-3 in combination with an immunological adjuvant. During immunisation her symptoms worsened and she developed severe, predominantly proximal axonal motor neuropathy and became bedridden. IgM antibodies against gangliosides GM2, GD3, and GQ1b were detected in serum obtained two weeks before and nine weeks after the onset of symptoms. Immunohistochemically, the patient’s IgM reacted with the tumour and co-localised with GQ1b. She improved neurologically following steroid treatment and became ambulatory.

Keywords: paraneoplastic syndrome; ophthalmoplegia; malignant melanoma; motor neuropathy

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