[Case of anti-TPO/gliadin antibody-positive cerebellar atrophy that responded to intravenous immunoglobulin therapy begun 16 years after onset].
We present a case of slowly progressive gait ataxia with a 16-year history in an 87-year-old woman. In 1994 she became aware of a slight unsteadiness while walking and cortical cerebellar atrophy was diagnosed. She had no familial history of neurological disorders. In 2007, idiopathic thrombocytopenic purpura (ITP) was diagnosed. The symptoms gradually worsened, and she was admitted in 2010 because she could not walk without support. MRI voxel-based morphometry (VBM) imaging showed atrophy of the entire cerebellum, and SPECT using eZIS showed reduced perfusion in the same regions. Her blood was positive for both anti-TPO antibody (42 IU/ml) and anti-gliadin antibody (20.2 EU). We therefore diagnosed autoimmune cerebellar atrophy. The patient showed a positive response to intravenous immunoglobulins (IVIg) and regained the ability to walk unassisted. Her posture and gait disturbance scores on the International Cooperative Ataxia Rating Scale had improved from 20 to 9. Even 16 years after onset, intravenous immunoglobulins were effective. In cases of prolonged disease, immunotherapy can be effective in autoimmune cerebellar atrophy and should not be excluded from the treatment choices.
Department of Neurology, Tokyo Medical University Hachioji Medical Center.
Nobuyuki
N
Tanaka
Hiroaki
H
Otake
Suguru
S
Ito
Kazuhide
K
Niiyama
Kazunori
K
Nanri
D000369:Aged, 80 and over; D001323:Autoantibodies; D001324:Autoantigens / Q000276:immunology*; D005260:Female; D020234:Gait Ataxia / Q000209:etiology; D005903:Gliadin / Q000276:immunology*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage*; D007453:Iodide Peroxidase / Q000276:immunology*; D033862:Iron-Binding Proteins / Q000276:immunology*; D008279:Magnetic Resonance Imaging; D009849:Olivopontocerebellar Atrophies / Q000150:complications / Q000175:diagnosis / Q000276:immunology* / Q000628:therapy*; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000150:complications; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome
D001323:Autoantibodies; D001324:Autoantigens; D016756:Immunoglobulins, Intravenous; D033862:Iron-Binding Proteins; D005903:Gliadin; C056658:TPO protein, human; D007453:Iodide Peroxidase