Abstract
Abstract
We retrospectively analyzed a patient with a positive anti-amphiphysin antibody status to characterize the clinical manifestations, diagnostic workup, and treatment results of anti-amphiphysin antibody disease that mimics multiple system atrophy (MSA), and we reviewed the relevant literature. The patient primarily presented with Parkinsonism, cerebellar ataxia, and autonomic dysfunction. An 82-year-old male presented with a subacute onset of bradykinesia, ataxia, and severe orthostatic hypotension. Brain magnetic resonance imaging (MRI) revealed hippocampal and cerebellar atrophy. Serum autoimmune neurological antibody testing was positive for anti-amphiphysin IgG (titer 1:320). Based on the multisystem involvement and exclusionary diagnostic workup, the patient was diagnosed with anti-amphiphysin antibody-associated MSA-like autoimmune neurological syndrome. After three sessions of double filtration plasmapheresis (DFPP) and sequential therapy with mycophenolate mofetil, the patient's motor function and orthostatic hypotension improved significantly. At the 6-month follow-up, the antibody titer decreased to 1:32, and the clinical condition remained stable. Anti-amphiphysin antibody syndrome can mimic MSA. Prompt neuronal autoantibody and long-term tumor screening are required for rapidly progressive atypical MSA-spectrum patients with severe autonomic failure. DFPP combined with immunosuppression achieves a favorable neurological prognosis.