Anti-alpha-enolase antibodies in cancer-associated retinopathy with small cell carcinoma of the lung.

PURPOSE: To present a case of cancer-associated retinopathy (CAR) in a patient with small cell carcinoma of the lung and antiretinal antibodies who experienced visual symptoms before diagnosis of cancer.

DESIGN: Case report.

METHODS: A 61-year-old man with a sudden loss of vision and photophobia was referred to the ophthalmology service. Antiretinal antibodies were determined by Western blot analysis.

RESULTS: The patient was found to have small cell carcinoma of the lung without metastasis and was surgically treated. His visual loss was asymmetrical. The full field ERG was normal, even though his vision in the right eye became progressively worse. The patient was treated with methylprednisolone and showed significant improvement. Before surgery, serum tests showed antiretinal protein 35-kD; 1 week after surgery, antiretinal protein 35-kD and 46-kD (alpha-enolase); and 1 month after surgery, anti-alpha-enolase.

CONCLUSIONS: Typical visual symptoms for paraneoplastic retinopathy are not always present. The absence of antirecoverin antibodies does not exclude a diagnosis of CAR.