Paraneoplastic autoimmune retinopathy associated with anti-enolase antibodies in a patient with lung cancer remission

Abstract

Background

Retinitis pigmentosa masquerades are a rare condition, often associated with paraneoplastic autoimmune retinopathy, specifically in patients with aggressive treatments. This case reports a patient with lung cancer in remission who developed progressive vision loss.

Case Report

A 55-year-old male with a history of squamous cell carcinoma of the lung in remission for one year, presented with photophobia and progressive vision loss over 6 months. Visual acuity was 0.2 in the right eye and 0.5 in the left. Fundus examination revealed peripheral pigmented specks, and OCT showed preservation of the subfoveal ellipsoid zone. Anti-enolase antibodies were positive. ERG showed abolished rod responses, absent photopic responses, and diffuse peripheral alterations.

Management

Given the positive anti-enolase antibodies and clinical presentation, the patient was treated with corticosteroids, immunoglobulins, and Rituximab.

Outcome

The patient showed visual acuity improvement (BCVA 0.3 OD and 0.9 OS) and stabilization of visual field deficits. New PEV testing showed mild changes in amplitudes and delayed latency in the right eye.

Conclusion

This case highlights the association between lung cancer and autoimmune retinopathy, likely contributing to the appearance of retinosis pigmentaria masquerades. Early diagnosis and treatment with immunosuppressive therapy can lead to functional recovery.