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An unusual cause of dysphagia
  1. S Payne,
  2. D Wilkins,
  3. R Howard
  1. St Thomas’ Hospital, London
  1. Correspondence to:
 Dr Sarah Payne
 St Bartholomew’s Hospital, West Smithfield, London EC1A 7BE;

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We report a case of a patient with Lambert Eaton Myasthenic Syndrome (LEMS) associated with small cell lung cancer (SCLC) presenting with a 2 year history of dysphagia. This presentation has not been described in previous literature.


A 71 year old right handed deck worker initially presented with a 6 month history of dysphagia, weight loss, nausea, and fatigue. He was cachetic with no other clinical signs to be found on examination. Baseline blood tests were unremarkable. Upper gastrointestinal (GI) endoscopy revealed a small hiatus hernia only. Subsequent investigations included a barium swallow, computer tomography (CT) scans of the chest and abdomen, oesophageal manometry, small bowel follow through, and laparoscopy, which were all normal. He was empirically started on cisapride and managed on an appropriate pureed diet.

Eighteen months after his initial presentation the patient complained of a gradual deterioration in his speech and problems with proximal muscle weakness. Clinical examination demonstrated an obvious dysarthria and broad based gait. There was no limb weakness or sensory neuropathy and reflexes were preserved with no post-tetanic potentiation. There was no disturbance of extraocular eye movements or ptosis. The patient did not display any cognitive …

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  • Competing interests: none declared