Severe hypokinesis caused by paraneoplastic anti-Ma2 encephalitis associated with bilateral intratubular germ-cell neoplasm of the testes.
We report a 40-year-old man with severe hypokinesis as paraneoplastic manifestation of a microscopic "carcinoma in situ" of the testis. The young age of the patient, along with progressive neurologic deterioration, detection of anti-Ma2 antibodies, and ultrasound findings of bilateral microcalcifications, led to bilateral orchiectomy, revealing the tumor in both testes. After orchiectomy, neurological symptoms stabilized, but the patient eventually died of systemic complications caused by his severe neurological deficits. Anti-Ma2 paraneoplastic encephalitis should be considered in patients with severe hypokinesis, and intensive investigation and aggressive approach to treatment is encouraged to prevent progression of the neurological deficits.
Matsumoto
Lumine
L
Department of Neurology, The University of Tokyo, Tokyo, Japan.
Yamamoto
Tomotaka
T
Higashihara
Mana
M
Sugimoto
Izumi
I
Kowa
Hisatomo
H
Shibahara
Junji
J
Nakamura
Koichiro
K
Shimizu
Jun
J
Ugawa
Yoshikazu
Y
Goto
Jun
J
Dalmau
Josep
J
Tsuji
Shoji
S
D000328:Adult; D000951:Antigens, Neoplasm / Q000276:immunology*; D001323:Autoantibodies / Q000097:blood*; D001921:Brain / Q000276:immunology / Q000473:pathology; D002278:Carcinoma in Situ / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology / Q000601:surgery; D018450:Disease Progression; D017809:Fatal Outcome; D006801:Humans; D018476:Hypokinesia / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology; D020363:Limbic Encephalitis / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D009373:Neoplasms, Germ Cell and Embryonal / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology / Q000601:surgery; D009419:Nerve Tissue Proteins / Q000276:immunology*; D009919:Orchiectomy; D010257:Paraneoplastic Syndromes / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology; D012671:Seminiferous Tubules / Q000473:pathology; D013736:Testicular Neoplasms / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology / Q000601:surgery
D000951:Antigens, Neoplasm; D001323:Autoantibodies; C119249:Ma2 antigen; D009419:Nerve Tissue Proteins