Abstract
ObjectivesTo refresh clinical diagnostic dilemmas in patients presenting with symptoms resembling to those of parkinsonism, to report rare association of colon cancer and paraneoplastic stiff person syndrome (SPS), and to draw attention on the possible correlation of capecitabine therapy with worsening of paraneoplastic SPS.MethodsCase report of the patient with paraneoplastic SPS due to colon cancer that was misdiagnosed as idiopathic Parkinson’s disease (iPD), whose symptoms worsened after beginning adjuvant capecitabine chemotherapy.ResultsWe describe a 55-year-old woman with subacute onset of symmetrical stiffness and rigidity of the truncal and proximal lower limb muscles that caused lower body bradykinesia, gait difficulties, and postural instability. Diagnose of iPD was made and levodopa treatment was initiated but failed to provide beneficial effect. Six months later, colon cancer was discovered and the patient underwent surgical procedure and chemotherapy with capecitabine thereafter. Aggravation of stiffness, rigidity, and low back pain was observed after the first chemotherapy cycle and capecitabine was discontinued. Furthermore, levodopa was slowly discontinued and low dose of diazepam was administered which resulted in partial resolution of the patient’s symptoms.ConclusionParaneoplastic SPS is rare disorder with clinical features resembling those of parkinsonian syndrome and making the correct diagnosis remains a challenge. The diagnosis of parkinsonian syndrome should be re-examined if subsequent examinations discover an associated malignant process. Although it remains unclear whether the patients with history of SPS are at the greater risk for symptoms deterioration after administration of capecitabine, clinicians should be aware of capecitabine side effects because recognition and appropriate management can prevent serious adverse outcomes.
Highlights
Stiff person syndrome (SPS) is a rare immune-mediated disorder, which was first described by Moersch and Woltman in 1956 [1]
Clinical features of paraneoplastic SPS can resemble those of parkinsonian syndrome and making the correct diagnosis can be challenging
We would like to emphasize that the diagnosis of idiopathic Parkinson’s disease (iPD) should be re-examined in patients with subacute debut, rapid progression of symptoms, lack of efficiency of dopaminergic therapy, and atypical symptoms
Summary
Stiff person syndrome (SPS) is a rare immune-mediated disorder, which was first described by Moersch and Woltman in 1956 [1]. The exact pathogenesis of SPS is still unclear, autoantibodies against glutamic acid decarboxylase (GAD), the enzyme responsible for the synthesis of γ-aminobutyric acid (GABA), are found in approximately 60% to 80% of SPS patients, suggesting important role of immune system in the etiology of SPS [4,5]. Autoimmune disorders such as diabetes, thyroiditis, and pernicious anemia occur more frequently in patients with SPS. SPS can occur as a paraneoplastic condition. Five percent of all SPS patients are associated malignancies [7]. Association of colon cancer and SPS has rarely been reported. We report a case of paraneoplastic SPS due to colon cancer that was misdiagnosed as idiopathic Parkinson’s disease (iPD) with a worsening of symptoms after inducing capecitabine in therapy
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