The horses are the first thought but one must not forget the zebras even if they are rare: Stiff person syndrome associated with malignant mesothelioma

Abstract

Stiff person syndrome (SPS) is a rare condition that causes rigidity in the muscles of the body and extremities, difficulty in walking, episodic spasms and progressive disability. SPS is generally seen together with autoimmune disorders such as diabetes mellitus, thyroiditis, vitiligo and pernicious anaemia. Rarely, it may develop as a paraneoplastic condition. SPS cases associated with breast cancer, small cell lung carcinoma, thymoma, Hodgkin's lymphoma and colorectal cancer have been reported in the literature. We present a case of a 58-year-old female patient who had malignant mesothelioma-associated SPS. Patients who have muscle spasms and difficulty in movement of joints should be evaluated for SPS before diagnosis of Parkinson's or other neurological disorders, and possible underlying malignancies should be excluded.

Is Stiff Person Syndrome Benefited by Physical Therapy Intervention? Summary of Case Reports

“…The stretching exercises provided to the subjects with SPS showed satisfactory results by increased ROM and decrease in muscle spasm and the identical results were found in other studies [2, 6, 12, 13]. The stretching exercises combined with relaxation exercises displayed a beneficial improvement in the ADL function [6] and a marked decrease in severity and frequency of muscle spasm [14]. These reported results strongly support the stretching exercise to be placed on the top line management in the treatment protocol of SPS.…”

A 75 year old male with recurrent unilateral pleural effusion and positive ANA

“…In addition, the patient had no other signs or symptoms consistent with SLE. Like many of the mentioned cases above, the initial diagnosis for presenting symptoms was not that of MPM but rather of autoimmune disease [[15], [16], [17]]. This suggests that perhaps the differential diagnosis of autoimmune disease presenting with cardiothoracic complaints should expand to include pleural-based malignancies, even in the absence of known asbestos exposure.…”

“…Autoimmune syndromes associated with mesothelioma have been numerous in the literature, including stiff-person syndrome [15], polyneuropathy [16], leukocytoclastic vasculitis [17], among others. There are at least two published cases of SLE-associated pericardial mesothelioma [18,19].…”

“…We did research into factors shared between patients of non-asbestos MPM and autoimmune disease in the absence of known asbestos exposure and found there are very few unifying characteristics between cases. In certain cases, classical autoimmune antibodies are non-reactive [15] while others are reactive [17]. An interesting aspect of the aforementioned case is the autoimmune serologies suggesting SLE, including positive ANA, positive anti-double stranded DNA antibodies, and positive rheumatoid factor.…”

Anti-glutamic acid decarboxylase antibody positive neurological syndromes

“…Patients positive for anti-GAD antibodies are also seen in the neurological setting who subsequently develop cancer 26. Carcinoma of the breast, small cell lung carcinoma, thymoma, and various other types of cancers like Hodgkin’s lymphoma and colon cancer are found to be associated with paraneoplastic SPS 34-37. According to Tomioka et al,30 paraneoplastic SPS patients with breast cancer or small cell lung cancer have anti-amphiphysin antibodies.…”