Anti-Ma2-associated encephalitis with normal FDG-PET: a case of pseudo-Whipple's disease.
BACKGROUND
A 39-year-old man presented with a history of several months of progressive personality changes, social withdrawal, bradykinesia, mutism, dysphagia, worsening gait, and difficulty with daily living activities. Examination revealed an atypical parkinsonian appearance with incomplete supranuclear ophthalmoplegia and an unusual oculomotor disorder characterized by both low-amplitude, intermittent opsoclonus, and slow, nystagmoid intrusions.


METHODS
Routine laboratory testing, autoimmune and infectious serologies, brain MRI, lumbar puncture, electroencephalogram, whole-body CT scan, paraneoplastic serologies, small bowel biopsy, 18F-fluorodeoxyglucose positron emission tomography CT scan, brain biopsy, and testicular ultrasound.


METHODS
Anti-Ma2 paraneoplastic encephalitis in association with metastatic testicular cancer; initially misdiagnosed as CNS Whipple's disease.


RESULTS
Corticosteroids, intravenous immunoglobulins, orchiectomy, muscle relaxants, mycophenolate mofetil, plasmapheresis, and bleomycin, etoposide and platinum chemotherapy.
Castle
James
J
Stanford University, CA, USA.
Sakonju
Ai
A
Dalmau
Josep
J
Newman-Toker
David E
DE
D000328:Adult; D000951:Antigens, Neoplasm / Q000276:immunology / Q000378:metabolism*; D001921:Brain / Q000473:pathology; D001930:Brain Injuries / Q000150:complications; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D004660:Encephalitis / Q000175:diagnosis* / Q000503:physiopathology; D017809:Fatal Outcome; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D008297:Male; D009419:Nerve Tissue Proteins / Q000276:immunology / Q000378:metabolism*; D010257:Paraneoplastic Syndromes / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D049268:Positron-Emission Tomography; D012640:Seizures / Q000209:etiology; D013736:Testicular Neoplasms; D008061:Whipple Disease / Q000175:diagnosis*
D000951:Antigens, Neoplasm; D007166:Immunosuppressive Agents; C119249:Ma2 antigen; D009419:Nerve Tissue Proteins; D019788:Fluorodeoxyglucose F18