Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 16, 2021; 9(17): 4423-4432
Published online Jun 16, 2021. doi: 10.12998/wjcc.v9.i17.4423
Anti-Yo antibody-positive paraneoplastic cerebellar degeneration in a patient with possible cholangiocarcinoma: A case report and review of the literature
Yue Lou, Shan-Hu Xu, Si-Ran Zhang, Qin-Fen Shu, Xiao-Li Liu
Yue Lou, Shan-Hu Xu, Si-Ran Zhang, Qin-Fen Shu, Xiao-Li Liu, Department of Neurology, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
Author contributions: Lou Y contributed to manuscript writing and interpretation of the data; Xu SH and Zhang SR contributed to acquisition and interpretation of the data; Shu QF and Liu XL contributed to the critical revision of the manuscript for intellectual content; all authors have read and approved the final manuscript.
Supported by Natural Science Foundation of Zhejiang Province, No. LQ19H090006; and Department of Health of Zhejiang Province, No. 2019KY260.
Informed consent statement: The patient provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no competing interests to report.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiao-Li Liu, MD, Chief Doctor, Department of Neurology, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, No. 1229 Gudun Road, Hangzhou 310000, Zhejiang Province, China. liuxiaoli0907@126.com
Received: February 9, 2021
Peer-review started: February 9, 2021
First decision: February 28, 2021
Revised: March 9, 2021
Accepted: March 25, 2021
Article in press: March 25, 2021
Published online: June 16, 2021
Abstract
BACKGROUND

Paraneoplastic cerebellar degeneration (PCD), which is rare in clinical practice, is closely related to autoimmunity. Cases positive for anti-Yo antibodies (anti-Purkinje cytoplasmic antibody 1) are the main subtype of PCD. PCD is subacute cerebellar degeneration, and while it progresses over weeks to months, its resultant deficits last much longer. Cancer patients with anti-Yo antibody-positive PCD are very rare. Most of them are breast cancer or ovarian cancer patients but also occasionally lung cancer patients.

CASE SUMMARY

A 61-year-old woman presented with sudden vertigo, nausea, and vomiting for approximately 10 d. The patient's neurological examination showed torsion with downbeat nystagmus and ataxia of the right limb and trunk. Laboratory examination found that the patient's cerebrospinal fluid and serum were anti-Yo antibody-positive, positron emission tomography computed tomography showed an increased metabolic rate in the retroperitoneal lymph nodes, and the pathology of lymph node punctures in the retroperitoneum and neck suggested adenocarcinoma of the pancreaticobiliary duct, which strengthens the hypothesis of paraneoplastic origin. Intravenous immunoglobulin (IVIg) 0.4 g/kg/d for 5 d and methylprednisolone 160 mg for 3 d were initiated, which was reduced to 80 mg for 3 d and then to 40 mg for 7 d. After treatment with IVIg and a steroid, the patient's vertigo and ataxia alleviated.

CONCLUSION

The patient's vertigo and ataxia alleviated after treatment, suggesting that early immunotherapeutic intervention may have certain value in stopping neurological loss.

Keywords: Paraneoplastic cerebellar degeneration, Anti-Yo antibody, Cholangiocarcinoma, Case report

Core Tip: We report for the first time a female patient with anti-Yo antibody-positive paraneoplastic cerebellar degeneration (PCD), who was later diagnosed with possible cholangiocarcinoma. She presented with sudden vertigo, nausea, and vomiting for approximately 10 d. The brain magnetic resonance imaging examination showed no obvious abnormalities. Finally, the pathology of lymph node punctures in the retroperitoneum and neck suggested adenocarcinoma of the pancreaticobiliary duct. The patient's symptoms alleviated with intravenous immunoglobulin and steroid treatment. This case highlighted that early immunotherapeutic intervention may stop and reverse neurological loss in PCD.