title: Multisystem atrophy made worse by lithium treatment in a hospice patient: a case report.
abstract: Multisystem atrophy is a neurologic condition defined as an adult-onset, progressive, neurodegenerative disease of unknown etiology. It carries a multisystem clinical course, including autonomic, urogenital, cerebellar, and parkinsonian features. Lithium toxicity, classically manifesting as increased thirst, polyuria, gastric distress, weight gain, tremor, fatigue, and mild cognitive impairment, can present in a similar manner.(1) We would like to present a patient diagnosed with progressive neurologic features typical of multisystem atrophy that also had bipolar disorder and had been taking lithium for many years. Despite normal lithium levels, it appeared as though a subclinical lithium toxicity was manifesting in the patient, and once lithium was discontinued, the patient was discharged from hospice with significant improvement in his presenting symptoms.
authors.affiliation: Hospice & Palliative Medicine Fellowship Program, University of Miami Miller School of Medicine Palm Beach Regional Campus, Atlantis, FL 33462, USA. dr.babinsky@gmail.com
authors.forename: Ellen
authors.initials: E
authors.lastname: Babinsky
authors.forename: Richard S
authors.initials: RS
authors.lastname: Levene
mesh_terms: D000368:Aged; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy; D017051:Hospice Care; D006801:Humans; D008094:Lithium / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D019578:Multiple System Atrophy / Q000139:chemically induced*
chemical_list: D014150:Antipsychotic Agents; D008094:Lithium