58 year old male patient started feeling weakness in both his legs 7 months ago, could stand but felt weak in both legs. he also had a mild but tolerable dyspnea, able to lie fully flat. several months later weakness got worse and would frequently fall. 1 month ago felt pain on the left side of his back and also experienced diaphoresis. urination and defecation remained normal. on examination. there was a 1x2 cm hard nodule on the right supraclavicular area. right lung had lag in expansion, decreased breath sounds, and dullness on percussion. both legs had a strength grading of 3/5 upper extremities normal. legs had decresed sensation and reflexes. cerebellar and cranial nerve functions intact. on the 2nd hospital day 1-2 liters of bloody pleural fluid was extracted from the right lung during a thoracentesis. what could this be?
well i was considering it might be lung cancer which metastasized to the spine. but since the weakness occured around the same time as the dyspnea instead of later in the course of the disease, i was thinking it might be small cell cancer of the lung manifesting with a paraneoplastic syndrome such as lambert-eaton syndrome. it explains the weakness and the decreased reflexes in the legs, what do you think?
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