A fifty-eight year old, African American woman presented with three months of oscillopsia, dizziness, scanning speech, and severe truncal ataxia. She was found to have stage IIIA lung adenocarcinoma. Brain MRI demonstrated abnormal T2/FLAIR signal in bilateral cerebellar hemispheres with lack of enhancement consistent with paraneoplastic involvement. No distinct paraneoplastic antibody was identified. She received pulse-dose steroids and IVIg with no improvement of cerebellar syndrome. A month later, she started chemotherapy and radiation therapy with transient cancer regression.
Because of metastatic spread, Durvalumab was initiated. She completed four doses that was complicated by worsening cerebellar symptoms and autoimmune colitis. During Durvalumab holiday, she received two courses of 5 PLEX treatments, two months apart, along with vigorous physical and speech therapy. Her neurologic symptoms and functional status improved considerably. At present time, patient is largely independent for ADLs and uses a walker. Repeat brain MRI revealed resolution of previously seen abnormalities.