title: Paraneoplastic stiff person syndrome associated with colon cancer misdiagnosed as idiopathic Parkinson's disease worsened after capecitabine therapy.
abstract: OBJECTIVE
  To 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.
  
  
  METHODS
  Case 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.
  
  
  RESULTS
  We 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.
  
  
  CONCLUSIONS
  Paraneoplastic 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.
authors.affiliation: Department of Oncology, Division of Gastrointestinal Malignancies, University Hospital Center Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia. sbadzek@gmail.com.
authors.forename: Sasa
authors.initials: S
authors.lastname: Badzek
authors.forename: Vladimir
authors.initials: V
authors.lastname: Miletic
authors.forename: Juraj
authors.initials: J
authors.lastname: Prejac
authors.forename: Irma
authors.initials: I
authors.lastname: Gorsic
authors.forename: Hilda
authors.initials: H
authors.lastname: Golem
authors.forename: Ervina
authors.initials: E
authors.lastname: Bilic
authors.forename: Domina
authors.initials: D
authors.lastname: Kekez
authors.forename: Niksa
authors.initials: N
authors.lastname: Librenjak
authors.forename: Stjepko
authors.initials: S
authors.lastname: Plestina
mesh_terms: D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects*; D000069287:Capecitabine; D003110:Colonic Neoplasms / Q000175:diagnosis* / Q000188:drug therapy; D003841:Deoxycytidine / Q000009:adverse effects / Q000031:analogs & derivatives*; D003951:Diagnostic Errors; D064420:Drug-Related Side Effects and Adverse Reactions / Q000209:etiology*; D005260:Female; D005472:Fluorouracil / Q000009:adverse effects / Q000031:analogs & derivatives*; D006801:Humans; D008875:Middle Aged; D010300:Parkinson Disease / Q000175:diagnosis* / Q000503:physiopathology; D011379:Prognosis; D016750:Stiff-Person Syndrome / Q000175:diagnosis* / Q000188:drug therapy
chemical_list: D000964:Antimetabolites, Antineoplastic; D003841:Deoxycytidine; D000069287:Capecitabine; D005472:Fluorouracil
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