Stiff Man Syndrome: A Diagnostic Dilemma in a Young Female with Diabetes Mellitus and Thyroiditis

Abstract

Stiff Person Syndrome (SPS), is a very rare neuroimmunologic disorder characterized by progressive muscle pain, rigidity, stiffness, and spasms. It can be very debilitating if misdiagnosed or not recognized in time. Herein we discuss a case of a female in her 20s who presented with an unsteady gait, lower extremity weakness, persistent leg pain, and stiffness few weeks after uncomplicated childbirth. She has type 1 diabetes mellitus (DM) and was diagnosed with thyroiditis in the course of her illness. The triad of thyroiditis, DM, and stiffness with normal neuroimaging in a young female patient is an unusual occurrence.

Dynamics of diabetes and obesity: Epidemiological perspective

“…This stiffness syndrome is characterized by painful spasms and ultimately affects the brain function. Approximately one-third of these syndrome patients eventually may develop DM [27, 61–71]. …”

“…Multiple conditions, including Down syndrome, Wolfram syndrome, Turner’s syndrome and Klinefelter’s syndrome are associated with changes in genome. Wolfram’s syndrome is an autosomal recessive disorder which is characterized with insulin-deficient diabetes along with the absence of β-cells [27, 71–86]. …”

Stiff-Person Syndrome With Early Onset in Infancy

“…Поэтому известны комбинации проявлений СРЧ с различными забо-Клинический разбор леваниями, в генезе которых играют роль аутоиммунные механизмы: инсулинзависимый сахарный диабет, аутоиммунный тиреоидит, тиреоидит Хашимото, гипотиреоз, тиреотоксикоз, пернициозная анемия, миастения, системная красная волчанка и некоторые другие нозологические формы. Реже прослеживается взаимосвязь СРЧ с некоторыми паранеопластическими заболеваниями, такими как тимома, мелкоклеточная карцинома легких, лимфогранулематоз, рак прямой и ободочной кишки, злокачественная мезотелиома, что диктует необходимость онкологической настороженности и обязательного углубленного диагностического поиска у каждого больного СРЧ с целью исключения вероятных неоплазий [2,[12][13][14][15].…”

An anti-GAD autoantibody-associated cerebellar syndrome case: a curable cause of ataxia

“…GAD is expressed not only in central nervous system (CNS), but also in pancreas, thyroid gland [2,3]. Anti-GAD autoantibodies (AGA) may destroy pancreatic cells and cause insulin-dependent diabetes mellitus (IDDM).…”

“…AGA is present in stiff-person syndrome also [2,3]. IDDM, thyroiditis and stiff-person syndrome may be seen concomitantly [2,3].…”