Anti-Glutamic Acid Decarboxylase Antibody-Associated Ataxia as an Extrahepatic Autoimmune Manifestation of Hepatitis C Infection: A Case Report

Abstract

Extrahepatic immunological manifestations of hepatitis C virus (HCV) are well described. In addition, antiglutamic acid decarboxylase (GAD) antibody-associated cerebellar ataxia is well-established entity. However, there have been no reports in the literature of anti-GAD antibody-associated ataxia as an extrahepatic manifestation of HCV infection. We report the case of a young woman with chronic hepatitis C virus and multiple extrahepatic autoimmune diseases including Sjögren syndrome and pernicious anemia who presented with subacute midline cerebellar syndrome and was found to have positive antiglutamic acid decarboxylase (GAD) antibody in the serum and cerebrospinal fluid. An extensive diagnostic workup to rule out neoplastic growths was negative, suggesting the diagnosis of nonparaneoplastic antiglutamic acid decarboxylase antibody-associated cerebellar ataxia as an additional extrahepatic manifestation of hepatitis C virus infection. The patient failed to respond to high-dose steroids and intravenous immunoglobulin. Treatment with the monoclonal antibody rituximab stabilized the disease. We postulate that anti-GAD associated ataxia could be an extrahepatic manifestation of HCV infection.

Clinical Spectrum of Stiff Person Syndrome: A Review of Recent Reports

“…Lobo et al 44 Scavone et al 24 Awad et al 23 Castelnovo et al 45 Cuturic et al 46 Ehler et al 6 Gnanapavan et al 47 Goldkamp et al 48 Mas et al 37 Piotrowicz et al 49 Turner et al 27 Witherick et al 28 Anagnostou et al 50 Amyradakis et al 51 Fekete and Jankovic 52 Fernandes et al 53 Iizuka et al 25 Lorenzoni et al 33 Najjar, at al. 22 Peeters et al 36 Qureshi et al 54 Tsai et al 55 Baroncini et al 26 Clardy et al…”

“…De la Casa-Fages et al 56 Damasio et al 57 Marinovic et al 58 Nakane et al 59 O'Toole et al 60 Sidransky et al 61 Sengupta et al 62 2013 63 Bordelon et al 64 Enuh et al 65 Fourlanos et al 66 Georgieva et al 67 Ho et al 68 Jung et al 69 Pagano et al 30 Rana et al 70 Sanders et al 71 Stern et al 72 Wuerfel et al 73 Bowen et al 29 Farooqi , and seven were positive for the following antibodies: three for anti-thyroid antibodies; two against parietal cells; one for antiamphiphysin; one for rheumatologic antibodies (Anti-Sjögren'ssyndrome-related antigen A and anti-nuclear antibody); 23 one for non-specific immunoglobulin (Ig)M against tick-borne meningoencephalitis; and one for anti-N-methyl-D-aspartate receptor antibodies. Four of these seven patients had two or more detectable autoantibodies in serum.…”

Clinical Spectrum of Stiff Person Syndrome: A Review of Recent Reports

“…Eight of these 11 had PERM. Testing for other antibodies was documented in 26/69 (37.7%), and seven were positive for the following antibodies: three for anti-thyroid antibodies; two against parietal cells; one for anti-amphiphysin; one for rheumatologic antibodies (Anti-Sjögren's-syndrome-related antigen A and anti-nuclear antibody); 23 one for non-specific immunoglobulin (Ig)M against tick-borne meningoencephalitis; and one for anti-N-methyl-D-aspartate receptor antibodies. Four of these seven patients had two or more detectable autoantibodies in serum.…”

“…Four of these seven patients had two or more detectable autoantibodies in serum. 23 – 26 Only the patient with antibodies against tick-borne meningoencephalitis had them in both serum and CSF. 6 Testing for oligoclonal bands (OCBs) was reported in 17 patients (24.6%), and they were detected in nine.…”

Ataxia associated with anti-glutamic acid decarboxylase antibodies

“…Пульс-терапия метилпреднизолоном в суммарной дозе 3500 мг, внутривенные инфузии иммуноглобулина человеческого и прием азатиоприна -с отчетливым положительным эффектом. Также описан случай подострого развития анти-GAD-А у пациентки 48 лет с хроническим гепатитом С и стабилизацией состояния на фоне терапии ГК и ритуксимабом [15]. Необходимо отметить, что для гепатита С характерно развитие сопутствующих аутоиммунных патологий (смешанная криоглобулинемия, синдром Шёгрена, аутоиммунный тиреоидит, тромбоцитопения и др.)…”