A Case of Opsoclonus-Myoclonus-Ataxia With Neuronal Intermediate Filament IgG Detected in Cerebrospinal Fluid

Melody Merati, Janet C. Rucker, Andrew McKeon, Steven J. Frucht, Jessica Hu, Laura J. Balcer, Steven L. Galetta

Research output: Contribution to journalArticlepeer-review

Abstract

ABSTRACT: A 62-year-old man presented with headache, fever, and malaise. He was diagnosed with Anaplasma phagocytophilum, confirmed by serum polymerase chain reaction, and started on oral doxycycline. After 5 days of treatment, the patient began to experience gait imbalance with frequent falls, as well as myoclonus, and confusion. Examination was notable for opsoclonus-myoclonus-ataxia (OMA) and hypometric saccades. Cerebrospinal fluid (CSF) autoimmune encephalitis panel demonstrated a markedly elevated neuronal intermediate filament (NIF) immunoglobulin G antibody titer of 1:16, with positive neurofilament light- and heavy-chain antibodies. These antibodies were suspected to have been triggered by the Anaplasma infection. Repeat CSF examination 8 days later still showed a positive immunofluorescence assay for NIF antibodies, but the CSF titer was now less than 1:2. Body computed tomography imaging was unrevealing for an underlying cancer. Our patient illustrates a postinfectious mechanism for OMA and saccadic hypometria after Anaplasma infection.

Original languageEnglish (US)
Pages (from-to)278-281
Number of pages4
JournalJournal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society
Volume42
Issue number2
DOIs
StatePublished - Jun 1 2022

ASJC Scopus subject areas

  • Medicine(all)

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