Anti-Hu antibodies may indicate a positive response to chemotherapy in paraneoplastic syndrome secondary to small cell lung cancer

Paraneoplastic encephalomyelitis (PEM) is a form of neurological dysfunction caused by the remote effect of small cell lung cancer (SCLC) on the brain. In certain cases it is associated with the presence of Anti-Hu antibodies. Up to 65% of patients with SCLC and PEM, who have Anti-Hu antibodies present, die of neurological complications rather than tumour progression. Chemotherapy is not believed to be beneficial. We describe a 58-year-old lady who was bed-bound and significantly disabled from paraneoplastic cerebellar degeneration. Her serology confirmed the presence of Anti-Hu antibodies and SCLC was confirmed at bronchoscopy. Following six courses of chemotherapy her neurological symptoms have remarkably improved, both subjectively and objectively, such that she is now independently mobile with a walking frame. Her tumour is still evident on bronchoscopy. We suggest that people with SCLC who are significantly disabled by neurological symptoms, should be tested for serum anti-neuronal antibodies and if Anti-Hu antibody positive, anti-neoplastic treatment should be considered despite poor performance status.