Rinsho Shinkeigaku (Clinical Neurology)

Brief Clinical Note

A case of acute cerebellar ataxia following infectious mononucleosis accompanied by intrathecal anti-glutamate receptor δ2 antibody

Hidetomo Murakami, M.D.1)3), Shoji Iijima, M.D.2), Mitsuru Kawamura, M.D.3), Yukitoshi Takahashi, M.D.4) and Hiroo Ichikawa, M.D.1)

1)Department of Neurology, Showa University Fujigaoka Hospital
2)Department of Neurology, Saiseikai Kanagawaken Hospital
3)Department of Neurology, School of Medicine, Showa University
4)Department of Pediatrics, National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders

An 18-year-old woman was admitted because of sore throat and pain in the epigastric region. On admission, she presented with swollen tonsils and hepatosplenomegaly. Blood examinations revealed the presence of atypical lymphocytes, liver damage and anti-VCA IgM and IgG antibodies. These findings led to diagnosis of infectious mononucleosis. After admission, her condition improved, but on hospital day 4, she suddenly developed cerebellar ataxia in the trunk and four limbs. Cranial MRI findings were normal. Cerebrospinal fluid (CSF) collected on hospital day 6 showed normal cell counts and normal concentrations of protein and glucose. EB virus DNA and anti-VCA IgM and IgG antibodies were negative and glutamate receptor δ2 antibody was positive in CSF collected on hospital day 11. We diagnosed acute cerebellar ataxia (ACA) and performed methylprednisolone pulse therapy. After this therapy, her cerebellar ataxia improved over a few days. This is the first reported case of ACA after EB virus infection presenting with glutamate receptor δ2 antibody in CSF. The glutamate receptor δ2 subunit is expressed on cerebellar Purkinje cells. Therefore, the presence of the antibody may be associated with cerebellar dysfunction. In the present case, secondary immune reactions after EB virus infection may have produced the antibody.
Full Text of this Article in Japanese PDF (963K)

(CLINICA NEUROL, 53: 555|558, 2013)
key words: infectious mononucleosis, acute cerebellar ataxia, Epstein-Barr virus, anti-glutamate receptor δ2 antibody

(Received: 12-May-12)