Anti-Ma2-associated encephalitis with normal FDG-PET: A case of pseudo-Whipple's disease

James Castle, Ai Sakonju, Josep Dalmau, David E. Newman-Toker

Research output: Contribution to journalArticlepeer-review

Abstract

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. Investigations. Routine laboratory testing, autoimmune and infectious serologies, brain MRI, lumbar puncture, electroencephalogram, whole-body CT scan, paraneoplastic serologies, small bowel biopsy, 18 F-fluorodeoxyglucose positron emission tomography CT scan, brain biopsy, and testicular ultrasound. Diagnosis. Anti-Ma2 paraneoplastic encephalit is in association with metastatic testicular cancer; initially misdiagnosed as CNS Whipple's disease. Management. Corticosteroids, intravenous immunoglobulins, orchiectomy, muscle relaxants, mycophenolate mofetil, plasmapheresis, and bleomycin, etoposide and platinum chemotherapy.

Original languageEnglish (US)
Pages (from-to)566-572
Number of pages7
JournalNature Clinical Practice Neurology
Volume2
Issue number10
DOIs
StatePublished - Oct 1 2006

ASJC Scopus subject areas

  • Clinical Neurology
  • Cellular and Molecular Neuroscience

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