Yulia Salamatova1, Irene Malaty2, Suman Ghosh3. 1. Department of Neurology, University of Florida College of Medicine - Jacksonville , Jacksonville, FL, 32202, USA. Yulia.salamatova@ufl.jax.edu. 2. Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA. 3. Division of Pediatric Neurology, Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL, USA.
Abstract
INTRODUCTION: Influenza virus has been associated with cases of Parkinsonism, yet a direct relationship has not been confirmed in the literature. Different mechanisms of post-infectious Parkinsonism have been proposed including inflammatory, oxidative stress, and autoimmune. We report a first to our knowledge case of pediatric autoimmune Parkinsonism with autoantibodies to dopamine D2L receptor (anti-DRD2L antibodies), who underwent deep brain stimulation (DBS) of bilateral globus pallidi (GPi). CASE REPORT: A 13-year-old girl presented with Parkinsonism features after a severe case of influenza A. She underwent extensive work-up and was found to have elevated titers for anti-DRD2L antibodies. Patient was initially treated with IVIG and plasmapheresis with mild improvement, but her condition continued to worsen. She was responsive to levodopa; however, she developed severe dyskinesia. Patient underwent DBS implantation resulting in partial improvement in bradykinesia, tremors, and dyskinesia. CONCLUSION: This case is meant to raise awareness of a rare potential autoimmune complication after influenza virus and to share the experience and outcome using DBS to palliate some of the symptoms.
INTRODUCTION: Influenza virus has been associated with cases of Parkinsonism, yet a direct relationship has not been confirmed in the literature. Different mechanisms of post-infectious Parkinsonism have been proposed including inflammatory, oxidative stress, and autoimmune. We report a first to our knowledge case of pediatric autoimmune Parkinsonism with autoantibodies to dopamine D2L receptor (anti-DRD2L antibodies), who underwent deep brain stimulation (DBS) of bilateral globus pallidi (GPi). CASE REPORT: A 13-year-old girl presented with Parkinsonism features after a severe case of influenza A. She underwent extensive work-up and was found to have elevated titers for anti-DRD2L antibodies. Patient was initially treated with IVIG and plasmapheresis with mild improvement, but her condition continued to worsen. She was responsive to levodopa; however, she developed severe dyskinesia. Patient underwent DBS implantation resulting in partial improvement in bradykinesia, tremors, and dyskinesia. CONCLUSION: This case is meant to raise awareness of a rare potential autoimmune complication after influenza virus and to share the experience and outcome using DBS to palliate some of the symptoms.