A Young Japanese Patient with Spinocerebellar Ataxia Type 3 Presenting Depressive State with Cenesthopathy and Delusion: A Case Report

Abstract Background: Depressive state is a common complication of spinocerebellar ataxia type 3 (SCA3). To the best of our knowledge, cases of SCA3 presenting with psychotic symptoms (i.e., cenesthopathy) have not been described. Here, we present a case of severe depressive state with cenesthopathy and delusion in a young Japanese man with SCA3.Case presentation: A 43-year-old Japanese man with SCA3 developed severe depressive state with associated cenesthopathy and delusion. He was treated with escitalopram (10 mg/day) and olanzapine (2.5 mg/day). Computed tomography showed atrophy of the cerebellum, bilateral superior cerebellar peduncle, and tegmentum of the pons. Single-photon emission computed tomography demonstrated reduced blood flow in the cerebellum, vermis, and brainstem. After eight weeks, his depressive state and delusion improved however his cenesthopathy persisted. Conclusions: We encountered a case of severe state with psychotic features (i.e., cenesthopathy and delusion) in a young Japanese man with SCA3. This study demonstrates that SCA3 may inherently present with severe depressive state and unique psychotic symptoms, even in younger patients where age-related neurodegeneration is unlikely. The complex function of the cerebellum in emotion and perception may play a crucial in the emergence of these psychiatric symptoms.