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, Daniel R. Gold, Marc Levin

Research output: Contribution to journalArticlepeer-review

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
Volume42
Issue number2
DOIs
StatePublished - Jun 1 2022
Externally publishedYes

ASJC Scopus subject areas

  • Ophthalmology
  • Clinical Neurology

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