{"paper_id":"04e3d8d0-7dfd-497e-9345-11a4774ebc81","body_text":"Paraneoplastic Autoimmune Cerebellar Atrophy Associated with Anti-Tr Antibody in a Known Case of Hodgkin Lymphoma: A Case Report Highlighting a Rare Presentation | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Paraneoplastic Autoimmune Cerebellar Atrophy Associated with Anti-Tr Antibody in a Known Case of Hodgkin Lymphoma: A Case Report Highlighting a Rare Presentation Saad Rehman, Rabia Iqbal, Rashid, Khizer Najeeb This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9602535/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Paraneoplastic cerebellar degeneration (PCD) is a very rare, autoimmune-mediated paraneoplastic neurological syndrome most commonly associated with Hodgkin lymphoma (HL). The pathogenesis involves production of anti-Tr (anti DNER) antibodies which mistakenly attacks Purkinje cells in the cerebellar cortex, leading to subacute cerebellar dysfunction. Early recognition and immunomodulatory therapies are critical for improving neurological outcomes. This case is novel as it describes anti-Tr antibody associated paraneoplastic cerebellar degeneration developing after remission of Hodgkin lymphoma, an uncommon presentation. It is also the few of reported case from Pakistan showing marked neurological recovery with plasmapheresis, underscoring the importance of early recognition and immunotherapy. Case Presentation: A 35-year-old male from Karachi, a diagnosed case of Hodgkin Lymphoma (HL), presented with progressive ataxia, clumsiness of both upper and lower limbs, dysarthria, and gait disturbance significantly limiting his ADLs. Neurological examination revealed cerebellar signs in our patients including dysdiadochokinesia, dysmetria, intention tremor, and truncal ataxia. MRI of the brain demonstrated bilateral cerebellar atrophy. CSF analysis showed mild pleocytosis with normal glucose and protein levels. Paraneoplastic antibody workup confirmed anti-Tr (anti DNER) positivity, establishing the diagnosis of PCD associated with HL. The patient received three sessions of plasmapheresis via double lumen catheter along with systemic corticosteroid therapy. Marked improvement was observed in patient condition with improvement in coordination, speech, and gait within weeks of therapy. Follow-up visits were planned for ongoing neurological assessment and relapse monitoring. Conclusion: This case emphasizes that paraneoplastic cerebellar degeneration can arise even after remission of Hodgkin Lymphoma. Prompt recognition and early immunotherapy can significantly improve neurological outcomes and help prevent lasting cerebellar impairment. Neurobiology of Disease Paraneoplastic cerebellar degeneration Hodgkin lymphoma Anti-Tr antibody DNER Plasmapheresis Cerebellar atrophy Paraneoplastic syndrome Immunotherapy Figures Figure 1 Figure 2 Introduction Paraneoplastic neurological syndromes (PNS) are rare, autoimmune complications of cancer that occur independently of direct tumor invasion or metastasis. They are triggered by an immune response directed against tumor antigens that are aberrantly expressed in the nervous system, leading to immune-mediated neuronal injury ( 1 , 2 ). Often, PNS precedes the clinical manifestations of the underlying malignancy. Onconeural antibodies play a central role in both diagnosis and pathogenesis; these antibodies are typically specific for the associated tumor type rather than a particular neurological syndrome ( 1 , 3 , 4 ). Among these, paraneoplastic cerebellar degeneration (PCD) is characterized by subacute onset of ataxia, dysarthria, and gait instability, typically characterized via autoimmune mediated destruction of cerebellar Purkinje cells ( 5 ). Hodgkin lymphoma (HL) is a hematologic malignancy most frequently linked to anti-Tr (anti DNER) antibodies, which are highly specific for PCD in HL patients ( 6 , 7 ). Recognizing this autoimmune etiology is crucial, as early administration of immunomodulatory therapies particularly corticosteroids, IVIG, or plasmapheresis can lead to partial or complete neurological recovery when initiated promptly ( 8 ). We present a rare case of anti Tr–positive PCD in a patient with HL from Karachi, Pakistan, who demonstrated notable improvement after plasmapheresis and corticosteroid therapy. Case Presentation A 35-year-old married male from Nawabshah, currently residing in Orangi Town, Karachi (South Pakistan) and employed as a driver, presented with progressive neurological complaints. One year prior, he was diagnosed with HL based on lymph node biopsy and received 12 cycles of chemotherapy at Dr. Ruth K. M. Pfau Civil Hospital, Karachi, with ongoing oncology follow-up and currently he was on remission. Several months after his HL diagnosis, he developed progressive clumsiness in both upper and lower limbs, slurred speech, and gait instability. Over subsequent months, he experienced increasing difficulty with fine motor activities such as feeding, buttoning clothes, and maintaining posture. He eventually became unable to sit without support. There was no history of diplopia, dysphagia, or bladder/bowel incontinence. On General Physical Examination, the patient was alert and oriented. The Speech was slurred but intelligible. The Cranial nerves were intact. Motor strength and tone were normal in all the limbs. Bilateral cerebellar signs were positive, including dysdiadochokinesia, dysmetria, intention tremor, and horizontal nystagmus. Gait was broad-based and unsteady with truncal ataxia. Sensory and reflex examinations were normal. Routine laboratory investigations were within normal limits. MRI of the brain revealed bilateral cerebellar atrophy consistent with PCD ( Fig. 1 , 2 ) . CSF analysis showed mild pleocytosis with normal protein and glucose levels. Paraneoplastic antibody panel confirmed anti-Tr (anti DNER) positivity. The patient underwent three sessions of plasmapheresis via double-lumen catheter along with systemic corticosteroid therapy. Marked improvement in coordination, speech, and gait was observed over subsequent weeks. The patient was advised on regular follow-up for neurological and oncologic monitoring. Discussion Anti-Tr (DNER) antibodies target delta/notch-like epidermal growth factor-related receptor proteins expressed on Purkinje cells, leading to immune-mediated cerebellar degeneration ( 9 , 10 , 11 , 12 ). This antibody association is highly specific for HL and rarely occurs with other malignancies ( 11 , 12 ). Patients typically develop progressive ataxia and dysarthria that may precede or coincide with the diagnosis of HL ( 13 ). MRI findings commonly show cerebellar atrophy, and CSF often reveal mild pleocytosis or normal results ( 14 ). In this patient, both characteristic imaging findings and positive anti-Tr antibodies supported the diagnosis. There is no standardized treatment protocol or regimen for anti-Tr associated PCD. Most reported cases advocate for early initiation of immunotherapy (plasmapheresis, corticosteroids, or IVIG) alongside control/eradication of the primary tumor ( 15 , 16 ). Early immunomodulation appears crucial in halting immune-mediated cerebellar injury before irreversible Purkinje cell loss. In our case, neurological improvement after three sessions of plasmapheresis and corticosteroid therapy highlights the potential benefit of early intervention. Previous reports have documented similar outcomes. A case reported an 11-year-old boy with Hodgkin lymphoma associated anti-Tr/DNER cerebellar ataxia, who presented with ataxia, dysarthria, and diplopia and showed positive anti-Tr antibodies on immunohistochemistry ( 17 ). Another case report discussed a 44-year-old man initially misdiagnosed with vertebrobasilar insufficiency, who was later found to have anti-Tr positive paraneoplastic cerebellar degeneration (PCD) preceding the diagnosis of Hodgkin lymphoma ( 18 ). Another case report discussed a 49-year-old man presented with subacute onset of ataxia, dizziness, and dysarthria over four weeks. Initial laboratory tests and brain MRI were unremarkable, but serum and cerebrospinal fluid analysis revealed anti-Tr antibody positivity, confirming a paraneoplastic autoimmune etiology ( 19 ). Another case report about a patient who developed cerebellar degeneration and prominent neuropsychiatric symptoms, leading to the diagnosis of Hodgkin lymphoma and detection of anti-Tr/DNER antibodies. The patient showed no response to methylprednisolone, intravenous immunoglobulin, rituximab, or tumor-directed therapy, but demonstrated marked neurological improvement following plasma exchange ( 20 ). Anti-Tr associated paraneoplastic cerebellar degeneration (PCD) should be suspected in patients with Hodgkin lymphoma presenting with progressive ataxia or dysarthria, even after achieving remission. MRI and antibody testing are crucial for diagnosis, and early initiation of immunomodulatory therapy particularly before the development of marked cerebellar atrophy can result in significant neurological recovery. This case further emphasizes that delayed-onset PCD following remission remains a possible but underrecognized manifestation requiring prompt evaluation and treatment. Conclusion Paraneoplastic cerebellar degeneration associated with anti-Tr antibodies is a rare but potentially reversible neurological manifestation of Hodgkin lymphoma. Early recognition and initiation of immunotherapy, alongside management of primary malignancy, can yield significant neurological recovery. Clinicians should maintain a high index of suspicion for this entity in HL patients presenting with progressive cerebellar dysfunction even when the patient is on remission. Abbreviations PCD Paraneoplastic Cerebellar Degeneration HL Hodgkin Lymphoma CSF Cerebrospinal Fluid MRI Magnetic Resonance Imaging IVIG Intravenous Immunoglobulin DNER Delta/Notch–like Epidermal Growth Factor–related Receptor ADL Activities of Daily Living Declarations Ethics Approval: This case report was reviewed and deemed exempt from formal ethical approval by the Institutional Review Board of Dr. Ruth K. M. Pfau Civil Hospital Karachi. Consent To Participate: Patient consented to participate in this case report. Consent for Publication: Written informed consent for publication of anonymized clinical details was obtained from the patient. Availability of Data and Materials: All data relevant to this case are contained within the manuscript. Competing Interests: All authors declare that they have no competing financial or personal interests that could have influenced the preparation of this manuscript. Funding: Not applicable. Compliance with Care Guidelines: This report was prepared in accordance with the CARE (Consensus-based Clinical Case Reporting) guidelines; the completed CARE checklist is available upon request. Code Availability: Not Applicable. Acknowledgement: The authors have no acknowledgments to declare. Authors Contribution: R. I was the responsible resident. She compiled the case and approved the final manuscript. S. R was the responsible medical intern who wrote the manuscript. H. K was the medical intern who edited, and cross checked the manuscript for grammar mistakes References Kannoth S (2012) Paraneoplastic neurologic syndrome: A practical approach. Ann Indian Acad Neurol 15(1):6–12. 10.4103/0972-2327.93267 Sutton I, Winer J (2002) The immunopathogenesis of paraneoplastic neurological syndromes. Clin Sci (Lond) 102(5):475–486. 10.1042/cs1020475 Storstein A, Vedeler C (2007) Paraneoplastic neurological syndromes and onconeural antibodies: clinical and immunological aspects. Adv Clin Chem 44:143–185. 10.1016/S0065-2423(06)44005-9 Honnorat J (2006) Onconeural antibodies are essential to diagnose paraneoplastic neurological syndromes. Acta Neurol Scand Suppl 183:63–68. 10.1111/j.1600-0404.2006.00699.x Nakano R, Sato S (1994) [Paraneoplastic cerebellar degeneration]. Nihon Rinsho 52(6):1583–1588 (Japanese) Geromin A, Candoni A, Marcon G, Ferrari S, Sperotto A, De Luca S, Fanin R (2006) Paraneoplastic cerebellar degeneration associated with anti-neuronal anti-Tr antibodies in a patient with Hodgkin's disease. Leuk Lymphoma 47(7):1429–1431. 10.1080/10428190500451440 Graus F, Dalmau JO, Valldeoriola F, Ferrer I, Reñé R, Marin C, Vecht C, Arbizu T, Targa C, Moll J (1997) Immunological characterization of a neuronal antibody (anti-Tr) associated with paraneoplastic cerebellar degeneration and Hodgkin's disease. J Neuroimmunol 74(1–2):55–61. 10.1016/S0165-5728(96)00200-9 Moll J, Henzen-Logmans S, van der Meché F, Vecht C (1993) Early diagnosis and intravenous immune globulin therapy in paraneoplastic cerebellar degeneration. J Neurol Neurosurg Psychiatry 56(10):1129–1131. 10.1136/jnnp.56.10.1129 Greene M, Lai Y, Baella N, Dalmau J, Lancaster E (2014) Antibodies to delta/notch-like epidermal growth factor-related receptor in patients with anti-Tr, paraneoplastic cerebellar degeneration, and Hodgkin lymphoma. JAMA Neurol 71(8):1003–1008. 10.1001/jamaneurol.2014.988 Cai Y, Liu J, Ren H, Shi F, Che J, Geng Q, Tan Y, Guan H, Di W (2022) Anti-Tr/DNER antibody–associated cerebellar ataxia: three rare cases report and literature review. Neurol Sci 43(10):6077–6085. 10.1007/s10072-022-06214-2 Peter E, Do L, Hannoun S, Muñiz-Castrillo S, Vogrig A, Wucher V, Pinto A, Chounlamountri N, Zakaria W, Rogemond V, Picard G, Hédou J, Ambati A, Alentorn A, Traverse-Glehen A, Manto M, Psimaras D, Mignot E, Cotton F, Desestret V, Honnorat J, Joubert B (2022) Cerebellar ataxia with anti-DNER antibodies. Neurol Neuroimmunol Neuroinflamm 9(3):e1155. 10.1212/NXI.0000000000001155 Campana IG, Silva GD (2021) Anti-Tr/DNER antibody–associated cerebellar ataxia: a systematic review. Cerebellum 20(4):567–578. 10.1007/s12311-021-01234-7 Ypma P, Wijermans P, Koppen H, Sillevis Smitt PS (2006) Paraneoplastic cerebellar degeneration preceding the diagnosis of Hodgkin's lymphoma. Neth J Med 64(3):86–89 Andrés C, Esquivel A, de Villoria JG, Graus F, Sánchez-Ramón S (2006) Unusual magnetic resonance imaging and cerebrospinal fluid findings in paraneoplastic cerebellar degeneration: a sequential study. J Neurol Neurosurg Psychiatry 77(4):559–561. 10.1136/jnnp.2005.073676 Greenlee J (2013) Treatment of paraneoplastic cerebellar degeneration. Curr Treat Options Neurol 15(2):185–200. 10.1007/s11940-013-0211-7 Adibi A, Adibi I, Danaei H (2025) Anti-Tr/DNER antibody–associated ataxia in a pediatric Hodgkin lymphoma survivor: successful treatment with plasmapheresis and IVIG. Pediatr Blood Cancer 72(4):e31012. 10.1002/pbc.31012 Gungor S, Kilic B, Arslan M, Ozgen U, Dalmau J (2017) Hodgkin’s lymphoma associated with paraneoplastic cerebellar degeneration in children: a case report and review of the literature. Childs Nerv Syst 33(6):987–991. 10.1007/s00381-017-3422-0 Arratibel N, Sobejano E, Morán JC, Díaz LG, Blázquez A, Baile M, Veiga A, Caballero M, García-Sanz R (2020) A case of paraneoplastic cerebellar degeneration that preceded the diagnosis of classical Hodgkin’s lymphoma by 16 months. Am J Case Rep 21:e921982. 10.12659/AJCR.921982 Kadubandi A, Midathada M, Jayagopal LA (2025) Hodgkin lymphoma presenting as paraneoplastic cerebellar degeneration: a case report. SAGE Open Med Case Rep 13:1–3. 10.1177/2050313X25127542 Crane P, Wynn DP, DeWitt D, Greenlee J (2022) Anti-Tr/DNER paraneoplastic cerebellar degeneration with marked cerebellar and psychological symptoms responsive to plasma exchange. Neurology 98(18 Suppl):2647. 10.1212/WNL.0000000000202647 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-9602535\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Case Report\",\"associatedPublications\":[],\"authors\":[{\"id\":633725853,\"identity\":\"6f16b2f9-b161-46eb-bc6b-faac6b06856b\",\"order_by\":0,\"name\":\"Saad 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20:54:44\",\"currentVersionCode\":1,\"declarations\":{\"humanSubjects\":true,\"vertebrateSubjects\":false,\"conflictsOfInterestStatement\":false,\"humanSubjectEthicalGuidelines\":true,\"humanSubjectConsent\":true,\"humanSubjectClinicalTrial\":true,\"humanSubjectCaseReport\":true,\"vertebrateSubjectEthicalGuidelines\":false},\"doi\":\"10.21203/rs.3.rs-9602535/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-9602535/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":108840896,\"identity\":\"8c41fad3-ce21-4831-ab9f-4e7ac9706d94\",\"added_by\":\"auto\",\"created_at\":\"2026-05-09 00:59:17\",\"extension\":\"png\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":514131,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eMRI (sagittal view) of brain showing cerebellar hypoplasia secondary to paraneoplastic syndrome caused by Hodgkin lymphoma.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"image.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-9602535/v1/0d2883162e84f438197761d2.png\"},{\"id\":108976676,\"identity\":\"8f9770d5-e44e-403c-92df-12ef6b0f73a1\",\"added_by\":\"auto\",\"created_at\":\"2026-05-11 11:27:56\",\"extension\":\"png\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":574787,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eAxial view of the MRI brain showing cerebellar hypoplasia.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"image.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-9602535/v1/e62e33c16fd42a49c888a76a.png\"},{\"id\":109203715,\"identity\":\"fa441d38-d733-4bf0-abf5-38d43a5d7d06\",\"added_by\":\"auto\",\"created_at\":\"2026-05-13 14:44:10\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":1209337,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-9602535/v1/e214dbfa-2632-4aa2-aec1-8c82c0de5d90.pdf\"}],\"financialInterests\":\"The authors declare no competing interests.\",\"formattedTitle\":\"\\u003cp\\u003e\\u003cstrong\\u003eParaneoplastic Autoimmune Cerebellar Atrophy Associated with Anti-Tr Antibody in a Known Case of Hodgkin Lymphoma: A Case Report Highlighting a Rare Presentation\\u003c/strong\\u003e\\u003c/p\\u003e\",\"fulltext\":[{\"header\":\"Introduction\",\"content\":\"\\u003cp\\u003eParaneoplastic neurological syndromes (PNS) are rare, autoimmune complications of cancer that occur independently of direct tumor invasion or metastasis. They are triggered by an immune response directed against tumor antigens that are aberrantly expressed in the nervous system, leading to immune-mediated neuronal injury (\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e). Often, PNS precedes the clinical manifestations of the underlying malignancy. Onconeural antibodies play a central role in both diagnosis and pathogenesis; these antibodies are typically specific for the associated tumor type rather than a particular neurological syndrome (\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e). Among these, paraneoplastic cerebellar degeneration (PCD) is characterized by subacute onset of ataxia, dysarthria, and gait instability, typically characterized via autoimmune mediated destruction of cerebellar Purkinje cells (\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eHodgkin lymphoma (HL) is a hematologic malignancy most frequently linked to anti-Tr (anti DNER) antibodies, which are highly specific for PCD in HL patients (\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e). Recognizing this autoimmune etiology is crucial, as early administration of immunomodulatory therapies particularly corticosteroids, IVIG, or plasmapheresis can lead to partial or complete neurological recovery when initiated promptly (\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eWe present a rare case of anti Tr\\u0026ndash;positive PCD in a patient with HL from Karachi, Pakistan, who demonstrated notable improvement after plasmapheresis and corticosteroid therapy.\\u003c/p\\u003e\"},{\"header\":\"Case Presentation\",\"content\":\"\\u003cp\\u003eA 35-year-old married male from Nawabshah, currently residing in Orangi Town, Karachi (South Pakistan) and employed as a driver, presented with progressive neurological complaints. One year prior, he was diagnosed with HL based on lymph node biopsy and received 12 cycles of chemotherapy at Dr. Ruth K. M. Pfau Civil Hospital, Karachi, with ongoing oncology follow-up and currently he was on remission.\\u003c/p\\u003e \\u003cp\\u003eSeveral months after his HL diagnosis, he developed progressive clumsiness in both upper and lower limbs, slurred speech, and gait instability. Over subsequent months, he experienced increasing difficulty with fine motor activities such as feeding, buttoning clothes, and maintaining posture. He eventually became unable to sit without support. There was no history of diplopia, dysphagia, or bladder/bowel incontinence.\\u003c/p\\u003e \\u003cp\\u003eOn General Physical Examination, the patient was alert and oriented. The Speech was slurred but intelligible. The Cranial nerves were intact. Motor strength and tone were normal in all the limbs. Bilateral cerebellar signs were positive, including dysdiadochokinesia, dysmetria, intention tremor, and horizontal nystagmus. Gait was broad-based and unsteady with truncal ataxia. Sensory and reflex examinations were normal. Routine laboratory investigations were within normal limits. MRI of the brain revealed bilateral cerebellar atrophy consistent with PCD \\u003cb\\u003e(\\u003c/b\\u003eFig.\\u0026nbsp;\\u003cspan refid=\\\"Fig1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e,\\u003cspan refid=\\\"Fig2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e\\u003cb\\u003e)\\u003c/b\\u003e. CSF analysis showed mild pleocytosis with normal protein and glucose levels. Paraneoplastic antibody panel confirmed anti-Tr (anti DNER) positivity.\\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003cp\\u003eThe patient underwent three sessions of plasmapheresis via double-lumen catheter along with systemic corticosteroid therapy. Marked improvement in coordination, speech, and gait was observed over subsequent weeks. The patient was advised on regular follow-up for neurological and oncologic monitoring.\\u003c/p\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eAnti-Tr (DNER) antibodies target delta/notch-like epidermal growth factor-related receptor proteins expressed on Purkinje cells, leading to immune-mediated cerebellar degeneration (\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e). This antibody association is highly specific for HL and rarely occurs with other malignancies (\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e). Patients typically develop progressive ataxia and dysarthria that may precede or coincide with the diagnosis of HL (\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eMRI findings commonly show cerebellar atrophy, and CSF often reveal mild pleocytosis or normal results (\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e). In this patient, both characteristic imaging findings and positive anti-Tr antibodies supported the diagnosis.\\u003c/p\\u003e \\u003cp\\u003eThere is no standardized treatment protocol or regimen for anti-Tr associated PCD. Most reported cases advocate for early initiation of immunotherapy (plasmapheresis, corticosteroids, or IVIG) alongside control/eradication of the primary tumor (\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e). Early immunomodulation appears crucial in halting immune-mediated cerebellar injury before irreversible Purkinje cell loss. In our case, neurological improvement after three sessions of plasmapheresis and corticosteroid therapy highlights the potential benefit of early intervention.\\u003c/p\\u003e \\u003cp\\u003ePrevious reports have documented similar outcomes. A case reported an 11-year-old boy with Hodgkin lymphoma associated anti-Tr/DNER cerebellar ataxia, who presented with ataxia, dysarthria, and diplopia and showed positive anti-Tr antibodies on immunohistochemistry (\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e). Another case report discussed a 44-year-old man initially misdiagnosed with vertebrobasilar insufficiency, who was later found to have anti-Tr positive paraneoplastic cerebellar degeneration (PCD) preceding the diagnosis of Hodgkin lymphoma (\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e). Another case report discussed a 49-year-old man presented with subacute onset of ataxia, dizziness, and dysarthria over four weeks. Initial laboratory tests and brain MRI were unremarkable, but serum and cerebrospinal fluid analysis revealed anti-Tr antibody positivity, confirming a paraneoplastic autoimmune etiology (\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e). Another case report about a patient who developed cerebellar degeneration and prominent neuropsychiatric symptoms, leading to the diagnosis of Hodgkin lymphoma and detection of anti-Tr/DNER antibodies. The patient showed no response to methylprednisolone, intravenous immunoglobulin, rituximab, or tumor-directed therapy, but demonstrated marked neurological improvement following plasma exchange (\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eAnti-Tr associated paraneoplastic cerebellar degeneration (PCD) should be suspected in patients with Hodgkin lymphoma presenting with progressive ataxia or dysarthria, even after achieving remission. MRI and antibody testing are crucial for diagnosis, and early initiation of immunomodulatory therapy particularly before the development of marked cerebellar atrophy can result in significant neurological recovery. This case further emphasizes that delayed-onset PCD following remission remains a possible but underrecognized manifestation requiring prompt evaluation and treatment.\\u003c/p\\u003e\"},{\"header\":\"Conclusion\",\"content\":\"\\u003cp\\u003eParaneoplastic cerebellar degeneration associated with anti-Tr antibodies is a rare but potentially reversible neurological manifestation of Hodgkin lymphoma. Early recognition and initiation of immunotherapy, alongside management of primary malignancy, can yield significant neurological recovery. Clinicians should maintain a high index of suspicion for this entity in HL patients presenting with progressive cerebellar dysfunction even when the patient is on remission.\\u003c/p\\u003e\"},{\"header\":\"Abbreviations\",\"content\":\"\\u003cdiv class=\\\"DefinitionList\\\"\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003ePCD\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eParaneoplastic Cerebellar Degeneration\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eHL\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eHodgkin Lymphoma\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eCSF\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eCerebrospinal Fluid\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eMRI\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eMagnetic Resonance Imaging\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eIVIG\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eIntravenous Immunoglobulin\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eDNER\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eDelta/Notch\\u0026ndash;like Epidermal Growth Factor\\u0026ndash;related Receptor\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eADL\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eActivities of Daily Living\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eEthics Approval:\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis case report was reviewed and deemed exempt from formal ethical approval by the Institutional Review Board of Dr. Ruth K. M. Pfau Civil Hospital Karachi.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent To Participate:\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003ePatient consented to participate in this case report.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent for Publication:\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eWritten informed consent for publication of anonymized clinical details was obtained from the patient.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAvailability of Data and Materials:\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eAll data relevant to this case are contained within the manuscript.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCompeting Interests:\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eAll authors declare that they have no competing financial or personal interests that could have influenced the preparation of this manuscript.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding:\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNot applicable.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCompliance with Care Guidelines:\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis report was prepared in accordance with the CARE (Consensus-based Clinical Case Reporting) guidelines; the completed CARE checklist is available upon request.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCode Availability:\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNot Applicable.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgement:\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors have no acknowledgments to declare.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthors Contribution:\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eR. I was the responsible resident. She compiled the case and approved the final manuscript. S. R was the responsible medical intern who wrote the manuscript. H. K was the medical intern who edited, and cross checked the manuscript for grammar mistakes\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003eKannoth S (2012) Paraneoplastic neurologic syndrome: A practical approach. Ann Indian Acad Neurol 15(1):6\\u0026ndash;12. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.4103/0972-2327.93267\\u003c/span\\u003e\\u003cspan address=\\\"10.4103/0972-2327.93267\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eSutton I, Winer J (2002) The immunopathogenesis of paraneoplastic neurological syndromes. 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JAMA Neurol 71(8):1003\\u0026ndash;1008. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1001/jamaneurol.2014.988\\u003c/span\\u003e\\u003cspan address=\\\"10.1001/jamaneurol.2014.988\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eCai Y, Liu J, Ren H, Shi F, Che J, Geng Q, Tan Y, Guan H, Di W (2022) Anti-Tr/DNER antibody\\u0026ndash;associated cerebellar ataxia: three rare cases report and literature review. Neurol Sci 43(10):6077\\u0026ndash;6085. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1007/s10072-022-06214-2\\u003c/span\\u003e\\u003cspan address=\\\"10.1007/s10072-022-06214-2\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003ePeter E, Do L, Hannoun S, Mu\\u0026ntilde;iz-Castrillo S, Vogrig A, Wucher V, Pinto A, Chounlamountri N, Zakaria W, Rogemond V, Picard G, H\\u0026eacute;dou J, Ambati A, Alentorn A, Traverse-Glehen A, Manto M, Psimaras D, Mignot E, Cotton F, Desestret V, Honnorat J, Joubert B (2022) Cerebellar ataxia with anti-DNER antibodies. Neurol Neuroimmunol Neuroinflamm 9(3):e1155. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1212/NXI.0000000000001155\\u003c/span\\u003e\\u003cspan address=\\\"10.1212/NXI.0000000000001155\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eCampana IG, Silva GD (2021) Anti-Tr/DNER antibody\\u0026ndash;associated cerebellar ataxia: a systematic review. 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J Neurol Neurosurg Psychiatry 77(4):559\\u0026ndash;561. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1136/jnnp.2005.073676\\u003c/span\\u003e\\u003cspan address=\\\"10.1136/jnnp.2005.073676\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eGreenlee J (2013) Treatment of paraneoplastic cerebellar degeneration. Curr Treat Options Neurol 15(2):185\\u0026ndash;200. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1007/s11940-013-0211-7\\u003c/span\\u003e\\u003cspan address=\\\"10.1007/s11940-013-0211-7\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eAdibi A, Adibi I, Danaei H (2025) Anti-Tr/DNER antibody\\u0026ndash;associated ataxia in a pediatric Hodgkin lymphoma survivor: successful treatment with plasmapheresis and IVIG. Pediatr Blood Cancer 72(4):e31012. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1002/pbc.31012\\u003c/span\\u003e\\u003cspan address=\\\"10.1002/pbc.31012\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eGungor S, Kilic B, Arslan M, Ozgen U, Dalmau J (2017) Hodgkin\\u0026rsquo;s lymphoma associated with paraneoplastic cerebellar degeneration in children: a case report and review of the literature. Childs Nerv Syst 33(6):987\\u0026ndash;991. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1007/s00381-017-3422-0\\u003c/span\\u003e\\u003cspan address=\\\"10.1007/s00381-017-3422-0\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eArratibel N, Sobejano E, Mor\\u0026aacute;n JC, D\\u0026iacute;az LG, Bl\\u0026aacute;zquez A, Baile M, Veiga A, Caballero M, Garc\\u0026iacute;a-Sanz R (2020) A case of paraneoplastic cerebellar degeneration that preceded the diagnosis of classical Hodgkin\\u0026rsquo;s lymphoma by 16 months. Am J Case Rep 21:e921982. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.12659/AJCR.921982\\u003c/span\\u003e\\u003cspan address=\\\"10.12659/AJCR.921982\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eKadubandi A, Midathada M, Jayagopal LA (2025) Hodgkin lymphoma presenting as paraneoplastic cerebellar degeneration: a case report. SAGE Open Med Case Rep 13:1\\u0026ndash;3. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1177/2050313X25127542\\u003c/span\\u003e\\u003cspan address=\\\"10.1177/2050313X25127542\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eCrane P, Wynn DP, DeWitt D, Greenlee J (2022) Anti-Tr/DNER paraneoplastic cerebellar degeneration with marked cerebellar and psychological symptoms responsive to plasma exchange. Neurology 98(18 Suppl):2647. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1212/WNL.0000000000202647\\u003c/span\\u003e\\u003cspan address=\\\"10.1212/WNL.0000000000202647\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":true,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"Dow University of Health Sciences\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Paraneoplastic cerebellar degeneration, Hodgkin lymphoma, Anti-Tr antibody, DNER, Plasmapheresis, Cerebellar atrophy, Paraneoplastic syndrome, Immunotherapy\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-9602535/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-9602535/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eBackground:\\u003c/h2\\u003e \\u003cp\\u003eParaneoplastic cerebellar degeneration (PCD) is a very rare, autoimmune-mediated paraneoplastic neurological syndrome most commonly associated with Hodgkin lymphoma (HL). The pathogenesis involves production of anti-Tr (anti DNER) antibodies which mistakenly attacks Purkinje cells in the cerebellar cortex, leading to subacute cerebellar dysfunction. Early recognition and immunomodulatory therapies are critical for improving neurological outcomes. This case is novel as it describes anti-Tr antibody associated paraneoplastic cerebellar degeneration developing after remission of Hodgkin lymphoma, an uncommon presentation. It is also the few of reported case from Pakistan showing marked neurological recovery with plasmapheresis, underscoring the importance of early recognition and immunotherapy.\\u003c/p\\u003e\\u003ch2\\u003eCase Presentation:\\u003c/h2\\u003e \\u003cp\\u003eA 35-year-old male from Karachi, a diagnosed case of Hodgkin Lymphoma (HL), presented with progressive ataxia, clumsiness of both upper and lower limbs, dysarthria, and gait disturbance significantly limiting his ADLs. Neurological examination revealed cerebellar signs in our patients including dysdiadochokinesia, dysmetria, intention tremor, and truncal ataxia. MRI of the brain demonstrated bilateral cerebellar atrophy. CSF analysis showed mild pleocytosis with normal glucose and protein levels. Paraneoplastic antibody workup confirmed anti-Tr (anti DNER) positivity, establishing the diagnosis of PCD associated with HL. The patient received three sessions of plasmapheresis via double lumen catheter along with systemic corticosteroid therapy. Marked improvement was observed in patient condition with improvement in coordination, speech, and gait within weeks of therapy. Follow-up visits were planned for ongoing neurological assessment and relapse monitoring.\\u003c/p\\u003e\\u003ch2\\u003eConclusion:\\u003c/h2\\u003e \\u003cp\\u003eThis case emphasizes that paraneoplastic cerebellar degeneration can arise even after remission of Hodgkin Lymphoma. Prompt recognition and early immunotherapy can significantly improve neurological outcomes and help prevent lasting cerebellar impairment.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Paraneoplastic Autoimmune Cerebellar Atrophy Associated with Anti-Tr Antibody in a Known Case of Hodgkin Lymphoma: A Case Report Highlighting a Rare Presentation\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2026-05-09 00:59:13\",\"doi\":\"10.21203/rs.3.rs-9602535/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"f29e44cc-a21a-4de5-ae98-6b9efaa74d03\",\"owner\":[],\"postedDate\":\"May 9th, 2026\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[{\"id\":67446394,\"name\":\"Neurobiology of Disease\"}],\"tags\":[],\"updatedAt\":\"2026-05-09T00:59:14+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2026-05-09 00:59:13\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-9602535\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-9602535\",\"identity\":\"rs-9602535\",\"version\":[\"v1\"]},\"buildId\":\"XKTyCvWXoU3ODBz1xrDgd\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}