Panegyres and Graves Journal of Medical Case Reports 2012, 6:155 http://www.jmedicalcasereports.com/content/6/1/155 was able to raise both legs against gravity. There was marked dysmetria in both lower limbs, again much less than as an in-patient. Deep tendon reflexes were 1+. There was no clonus. She had nystagmus in lateral gaze without gaze paresis. There was some limitation in her upward gaze. Convergence and accommodation reaction were normal. The cranial nerve examination was other- wise normal. When reassessed in August 2011 she remained bed bound without changes in the neurological examination. She remains alive to this day, dependent on staff for all acts of daily living and requiring feeding assistance. Her weight ranges from 52.8 kg to 61.8 kg. Discussion PCD is rare and not commonly associated with endo- metrial cell carcinoma, particularly clear cell endometrial carcinoma [4]. PCDs have however been associated with fallopian tube adenocarcinoma [5]. To the best of our knowledge this is the first case of clear cell endometrial carcinoma with anti-Yo antibodies in serum and CSF, associated with anti-GAD antibodies in serum and CSF; observations that extend the known associations and relationships of both of these antibodies and indicates the importance of an aberrant immune response in PCD. Our patient’s case is also unique in that 14-3-3 proteins were identified in the CSF, probably related to neuronal death. Furthermore our patient was given intravenous immunoglobulin and had surgical treatment for the endometrial carcinoma. She has remained alive though disabled for over three years. This therapeutic outcome supports the notion of a poor therapeutic re- sponse to intravenous immunoglobulin in patients with anti-Yo associated PCDs [6] and not a positive treatment effect observed by others [7,8]. The titers of anti-Yo and anti-GAD antibodies in our patient decreased in both blood and CSF following treat- ment, reflecting the reduced immunological response to the tumor provided by its surgical extirpation and treat- ment with intravenous Ig (Table 1). Our patient’s case highlights that the presence of the 14-3-3 protein in CSF, even though having high sensitivity and specificity for prion diseases may also be found with PCDs, includ- ing non-clear cell carcinoma of the uterus [9]. This is an important practice point in that in a patient with a cere- bellar syndrome, where there might be considerations of a prion disease and where 14-3-3 proteins are found, the physician needs to consider the possibility of an under- lying cancer. 14-3-3 proteins have previously been observed in a pa- tient with anti-GAD associated cerebellar ataxia [10]. Furthermore anti-GAD antibodies are not only asso- ciated with stiff-person syndrome but in about 20% with cerebellar ataxia [11]. Our patient is distinctive in that Page 3 of 4 both the anti-Yo and anti-GAD antibodies can be impli- cated in the cerebellar degeneration. The pathophysiology of the cerebellar degeneration is probably a consequence of a direct cytotoxic effect of the anti-GAD antibodies on the Purkinje cells [12] and possibly an apoptotic effect of the anti-Yo antibody after uptake by cerebellar Purkinje cells [13-15]. The patho- physiological effects of both antibodies resulted in the fulminating and devastating cerebellar syndrome in our patient. The initial cell damage might involve cell- mediated immunity, as these antibodies recognize intra- cellular antigens; this mechanism is supported by the unsuccessful attempts to transfer the disease in animals by antibodies or immunization. Conclusions To the best of our knowledge this is the first report of a PCD caused by clear cell carcinoma of the uterus with both anti-Yo and anti-GAD antibodies, in association with 14-3-3 proteins in CSF. These observations increase our understanding of the antibodies related to PCD in gynecological malignancies and is of relevance to neurol- ogists, gynecologists, general internists, oncologists and clinical immunologists. Consent Written informed consent was obtained from the patient for publication of this case report. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Competing interests The authors declare that they have no competing interests. Authors’ contributions PKP and AG were both responsible for diagnosis and patient management, and both wrote and approved the final manuscript. Received: 3 November 2011 Accepted: 13 June 2012 Published: 13 June 2012 References 1. Klockgether T: Sporadic ataxia with adult onset: classification and diagnostic criteria. Lancet 2010, 9:94–104. 2. Panegyres PK: Diagnosis and management of Whipple’s disease of the brain. Pract Neurol 2008, 8:311–317. 3. 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