Anti-RGS8 Paraneoplastic Neurologic Syndrome Presenting with Skew Deviation and Mild Cerebellar Dysfunction

Area of Science:

• Neurology
• Oncology
• Immunology

Background:

• Paraneoplastic neurologic syndromes (PNS) are immune-mediated disorders triggered by cancer.
• RGS8-associated PNS is a rare condition typically causing severe cerebellar dysfunction.
• Lymphomas are frequently associated with paraneoplastic neurologic syndromes.

Observation:

• A patient presented with mild cerebellar dysfunction, including ocular motor abnormalities and gait impairment.
• Cerebrospinal fluid (CSF) analysis revealed elevated protein and a neural-restricted antibody pattern.
• Abdominal CT identified mesenteric lymphadenopathy, later diagnosed as follicular B-cell lymphoma.

Findings:

• The patient's antibody pattern was identified as anti-RGS8 antibodies after four years.
• This represents the first reported case of RGS8-PNS with subtle cerebellar signs and ocular motor predominance.
• The associated malignancy was a low-grade follicular B-cell lymphoma.

Implications:

• This case expands the clinical spectrum of RGS8-associated PNS.
• Early identification of RGS8 antibodies may be crucial for diagnosing subtle PNS presentations.
• Understanding the link between RGS8-PNS and low-grade lymphoma can improve patient management and prognosis.