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Abstract Details

Presence of VGKC complex: CASPR2 / LGI1 antibodies in hydrocele fluid in Morvan's syndrome
Autoimmune Neurology
Autoimmune Neurology Posters (7:00 AM-5:00 PM)
084

A 50-year-old gentleman underwent a scrotal tap with the chemicals instillation into the scrotal sac for treatment of hydrocele. Two months later, he developed low backache and twitching of thigh and calf muscles. On examination, he was profusely sweating on face and hands. He was febrile, with an elevated blood pressure of 150/90mmHg, deep tender reflexes were depressed. Slight tremors of outstretched hands and anterior abdominal wall noted with intermittent twitching observed over the calf and thigh muscles. Blood investigation revealed a high sugar level of 249mg/dl and the presence of the CASPR-2 antibody.  The EMG study showed spontaneous grouped discharges in the form of doublets and triplets. A scrotal ultrasound revealed epididymitis, orchitis with an interstitial fluid collection. A 10ml yellowish fluid aspirated from the contralateral scrotum and sent to VGKC detection. A test conducted on the hydrocele fluid with screening in 1:10 titer turned out to be positive for both CASPR2 (end titer 1:160) and LGI1 (end titer 1:80) antibodies VGKC complex. Discussions: An unusual association of Morvon's syndrome (MoS) after scrotal tap and injection of sclerosing agent for hydrocele treatment seen in the Indian subcontinent. These young individuals developed clinical features suggestive of MOS, six weeks to 3 months after the procedure. Symptoms spontaneously resolved within six months of onset. The present case may suggest VGKC complex antibody production in scrotal sac fluid in response to a robust antigenic challenge in an otherwise immune privilege organ system.

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Authors/Disclosures
Sanjay Sharma, MD (Ramkrishna Care Medical Sciences Pvt. Ltd.)
PRESENTER
Dr. Sharma has nothing to disclose.
No disclosure on file
No disclosure on file