Immune Mediated Cerebellar Ataxia: An Unknown Manifestation of Graft-versus-Host Disease.

Abstract

Neurologic complications of allogeneic hematopoietic cell transplantation (allo-HCT) include infections, cerebrovascular events, therapy-induced neurotoxicity, recurrent malignancies, and neurologic manifestations of graft-versus-host disease (GVHD). Anti-glutamic acid decarboxylase (GAD) antibody-associated cerebellar ataxia is a well-established disorder of autoimmune origin, but there are no reports in the literature of its occurrence following allo-HCT. We describe a middle-aged woman with chronic GVHD after allo-HCT who presented with a rapidly progressive cerebellar syndrome. Thorough investigation revealed only cerebellar atrophy on brain imaging and positive anti-GAD65 antibodies in serum and cerebrospinal fluid suggesting the diagnosis of anti-GAD antibody-associated cerebellar ataxia. Despite prompt treatment with high-dose corticosteroids, intravenous immunoglobulins, and rituximab, the patient's condition rapidly deteriorated, and she died 4 months later. This case suggests that anti-GAD antibody-associated cerebellar ataxia may be a rare manifestation of chronic GVHD.

• Authors: Liat Shargian-Alon, Pia Raanani, Uri Rozovski, Tali Siegal, Shlomit Yust-Katz, Moshe Yeshurun
• Journal: Acta haematologica (Acta Haematol) Vol. 141 Issue 1 Pg. 19-22 ( 2019) ISSN: 1421-9662 [Electronic] Switzerland
• PMID: 30439710 (Publication Type: Case Reports, Journal Article)
• Copyright: © 2018 S. Karger AG, Basel.

Chemical References

• Antineoplastic Agents, Immunological
• Autoantibodies
• Immunoglobulins, Intravenous
• Rituximab

Topics

• Antineoplastic Agents, Immunological (therapeutic use)
• Autoantibodies (blood)
• Cerebellar Ataxia (complications, diagnosis, drug therapy)
• Female
• Graft vs Host Disease (diagnosis, etiology)
• Hematopoietic Stem Cell Transplantation (adverse effects)
• Humans
• Immunoglobulins, Intravenous
• Leukemia, Myeloid (therapy)
• Middle Aged
• Rituximab (therapeutic use)
• Transplantation, Homologous (adverse effects)