A patient with type 1 diabetes mellitus and cerebellar ataxia associated with high titer of circulating anti-glutamic acid decarboxylase antibodies.

A 66-year-old Japanese woman presenting with recent onset of type 1 diabetes mellitus and cerebellar ataxia was admitted to our hospital. Physical examination on admission revealed coordinate disturbance due to cerebellar ataxia, and the laboratory examination showed marked hyperglycemia with ketosis and impaired insulin secretion. Anti-glutamic acid decarboxylase (GAD) antibodies in high titer were detected in patient's serum. Immunoblotting showed the patient's serum reacted with a 65 kDa protein in tissue extracts from rat pancreas and cerebellum, and immunohistochemical study produced positive immunostaining in the pancreatic islets of Langerhans, the axons of Purkinje cells and the nerve terminals in the granular layers of cerebellum of the rat. This is the first case presenting with concomitant type 1 diabetes and cerebellar ataxi associated with high titers of circulating anti-GAD antibodies which may play a critical role in the development of the diseases.