Awad Amer, Stüve Olaf, Mayo Marlyn, Alkawadri Rafeed, Estephan Bachir
Baton Rouge Neurology Associates, Baton Rouge General Medical Center, Baton Rouge, LA, USA.
Case Rep Neurol Med. 2011;2011:975152. doi: 10.1155/2011/975152. Epub 2011 Jul 10.
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.
丙型肝炎病毒（HCV）的肝外免疫表现已有充分描述。此外，抗谷氨酸脱羧酶（GAD）抗体相关的小脑共济失调是一种公认的疾病。然而，文献中尚无关于抗GAD抗体相关共济失调作为HCV感染肝外表现的报道。我们报告了一例患有慢性丙型肝炎病毒且伴有多种肝外自身免疫性疾病（包括干燥综合征和恶性贫血）的年轻女性病例，该患者出现亚急性中线小脑综合征，血清和脑脊液中抗谷氨酸脱羧酶（GAD）抗体呈阳性。为排除肿瘤生长进行的广泛诊断检查结果为阴性，提示诊断为非副肿瘤性抗谷氨酸脱羧酶抗体相关小脑共济失调，这是丙型肝炎病毒感染的另一种肝外表现。该患者对大剂量类固醇和静脉注射免疫球蛋白治疗无反应。使用单克隆抗体利妥昔单抗治疗使病情稳定。我们推测抗GAD相关共济失调可能是HCV感染的肝外表现。
