CASPR-2 Antibody Associated Autoimmunity in the Setting of COVID-19 (Infection, Vaccination, or Both?) and Chronic Lymphocytic Leukemia: Case Report and Review of the Literature

Objective To report a case of Anti-Contactin-Associated Protein-like2 (CASPR-2) autoimmunity in patient with low-grade Chronic Lymphocytic Leukemia (CLL) following COVID-19 vaccination and infection. Background Anti-CASPR2 antibody disorder has been associated neoplastic disorders like thymoma. Recent reports enlist as apotential trigger CASPR2 autoimmunity. While the clinical presentations are similar, management differs based on underlying etiology. Design/Methods We review anti-CASPR2-antibody concurrent low grade CLL recent history Additionally, we literature discuss therapeutic challenges. Results A 73-years old male presented five months progressive fatigue, weight loss, diffuse sweating, muscle cramps, neuropathic pain. He eventually developed bilateral upper lower facial weakness. Patient contracted mild infection two prior one month to his symptom onset. His exam was remarkable for weakness, fasciculations sensory neuropathy trunk extremities. diagnostic work up including bone marrow biopsy consistent chronic lymphocytic leukemia (CLL)-like immunophenotype. Cerebrospinal fluid (CSF) analysis WBC (lymph-dominant) protein 74 mg/dl. Serum paraneoplastic panel revealed positive titer 1:100. Magnetic Resonance Imaging (MRI) brain showed enhancement cranial nerve VII. After lack response IV methylprednisone (1 gram 5 days), treated single cycle immunoglobulin (IVIG). had complete recovery symptoms except residual remains stable at six post-treatment follow-up. Conclusions or setting previously reported. However, association never been. trial IVIG could be beneficial patients viral-spike protein-induced who do not otherwise meet criteria treatment.