Successful Treatment with Methylnaltrexone and IVIG for Paraneoplastic Syndrome-Associated Intestinal Pseudo-Obstruction.

Address correspondence to: Dr. Jacqueline L. Wolf, E/DA 501, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA 02215; Tel: 617-667-1676; Fax: 617-667-2767; E-mail: [email protected] Paraneoplastic syndromes are systemic disorders that are associated with malignancy but are not directly due to the local effects of a tumor mass or its metastases. These syndromes are most commonly associated with small cell lung cancer or thymoma.1 Paraneoplastic syndromes frequently present with gastrointestinal dysmotility and can lead to intestinal pseudo-obstruction. Many patients with paraneoplastic syndromes have detectable anti-Hu antibodies in the serum. We report a patient with non–small cell lung cancer who presented with pseudoobstruction of the entire gastrointestinal tract that was successfully treated with intravenous immunoglobulin (IVIG) and subcutaneous methylnaltrexone (Relistor, Salix).