Pearls & Oy-sters: KLHL11 IgG Paraneoplastic-Associated Hearing Loss and Rhombencephalitis in a Woman With Metastatic Müllerian Tumor

Neurology. 2024 Apr 9;102(7):e209187. doi: 10.1212/WNL.0000000000209187. Epub 2024 Mar 14.

Abstract

Kelch-like protein-11 (KLHL11) immunoglobulin G (IgG) is a recently reported paraneoplastic autoantibody associated with rhombencephalitis, which commonly presents with ataxia, diplopia, vertigo, hearing loss, tinnitus, and gaze palsies. The association of this high-risk paraneoplastic autoantibody with testicular germ cell tumors is widely accepted, but it has not been associated with Müllerian tumors. In this study, we report a woman without a known germ cell tumor presenting with signs and symptoms suggesting autoimmune encephalitis. She was found to have metastatic ovarian serous carcinoma with KLHL11 immunoreactivity on histopathology. This case demonstrates a rare cancer association of KLHL11 IgG-seropositive rhombencephalitis with Müllerian tumor and highlights that this autoantibody can also be detected in female patients. Thus, this case expands on the current knowledge of KLHL11-related autoimmune encephalitis including the paraneoplastic presentation, associated tumor types, and management of this syndrome in women.

Publication types

  • Case Reports

MeSH terms

  • Autoantibodies
  • Autoimmune Diseases of the Nervous System*
  • Carrier Proteins
  • Deafness*
  • Encephalitis*
  • Female
  • Hashimoto Disease*
  • Hearing Loss* / etiology
  • Humans
  • Immunoglobulin G
  • Testicular Neoplasms*

Substances

  • Autoantibodies
  • Carrier Proteins
  • Immunoglobulin G
  • KLHL11 protein, human

Supplementary concepts

  • Hashimoto's encephalitis