Anti-Hu antibodies, sensory neuropathy, and Holmes–Adie syndrome in a patient with seminoma

High titers of anti-Hu antibodies indicate the paraneoplastic genesis of neurologic syndromes with high specifity.1,2⇓ In most cases, the primary tumor is identified as small cell lung cancer (SCLC); reports of other tumors are rare.2,3⇓ Here, we report a patient positive for anti-Hu antibodies who developed a sensory neuropathy and Holmes–Adie syndrome (HAS). The only tumor that was detected was a unilateral seminoma. After tumor removal, anti-Hu antibodies eventually vanished. The then 31-year-old patient was first admitted to the hospital in June 2000 with a 6-week history of hypoesthesia and paresthesia of his feet. He was a nonsmoker and had no relevant past or family history. Neurologic examination revealed missing Achilles tendon reflexes, marked decrease in proprioceptive and kinesthetic sensation in both feet, and mild sensory gait ataxia. CSF showed elevated protein levels (1,747 mg/L); all other findings, including oligoclonal bands and tests for borreliosis and syphilis, were normal, as were serum tests for autoantibodies, diabetes, folic acid, …