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Images in Neurology |

Chemotherapy-Associated Peripheral Sensory Neuropathy Assessed Using In Vivo Corneal Confocal Microscopy

Giulio Ferrari, MD; Franco Gemignani, MD; Claudio Macaluso, MD
Arch Neurol. 2010;67(3):364-365. doi:10.1001/archneurol.2010.17.
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A 75-year-old man presented to our ophthalmology department for his yearly examination. He had metastatic colorectal carcinoma and had been receiving antineoplastic therapy with 2500 mg/m2 of capecitabine for 2 weeks, followed by 1 week of rest, and 3 subsequent cycles of 3 weeks each. No ocular symptoms were described. However, the patient had paresthesias of the feet, legs, and hands. The symptoms had started after the third cycle of treatment.

The clinical examination showed unremarkable ophthalmic findings. A reduction in light touch sensation in the both the lower and upper limbs was observed. Sensation was intact in the periocular area and the face. His corneal reflex was maintained. We proposed further clinical investigation with electroneuromyography and nerve skin biopsy, which the patient refused.

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In vivo corneal confocal microscopy of nerves in the subepithelial plexus (A and B) and stroma (C and D) of a healthy subject vs a patient affected with capecitabine-associated neuropathy. Note the reduction in the number of main nerve trunks, increased tortuosity, beading, and sprouting (small arrow, D). Keratocytes are indicated with a large arrow (D).

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