Anti-Ma2-associated encephalitis in a patient with testis carcinoma

A 30-year-old man presented with 3 months of alternating hyper- and hypothermia, libido loss, hypersomnia, and headache. Neurologic examination was unremarkable. Laboratory tests revealed low serum testosterone and hypocortisolism. MRI showed hypothalamic T2 hyperintensity and contrast enhancement (figure, A). CSF analysis showed moderate lymphocytosis. Cerebral infections and malignancies were excluded. Methylprednisolone was started based on a working-diagnosis of lymphocytic hypothalamitis. After initial improvement, the patient relapsed, with MRI showing limbic involvement (figure, B). Serum and CSF screening was positive for anti-MA2. Ultrasonography showed microcalcification of the right testicle, which was resected. Histology showed focal germ cell neoplasia.

Source: Neurology - April 10, 2016 Category: Neurology Authors: Suwijn, S. R., Klieverik, L. P., Odekerken, V. J. J. Tags: Encephalitis, Paraneoplastic syndrome NEUROIMAGES Source Type: research