IM resident published
Internal Medicine PGY3 Min Xu, MD, recently co-authored an article in the journal South Dakota Medicine. "Finding our way: Diagnostic perils and the stiff person syndrome" was published in the September 2009 issue of the journal, with Jerome W. Freeman, MD, FACP; Susan Anderson, MD; and Janet Lindemann, MD, co-authoring the article.
Dr. Xu helped write the article during her neurology rotation with Dr. Freeman. Her five previous publications were primarily research papers on total hip arthroplasty; this is her first published clinical case report. Dr. Xu said she collected information from Dr. Freeman's office about cases discussed in the article, investigated the case, and evaluated the similarities between the cases. She also wrote a summary of the previous case reports.
"The best lesson from these two patients is the importance of not attributing all new symptoms to a patient's putative diagnosis," Dr. Freeman explained.
The article analyzed two cases in which the symptoms led to incorrect initial diagnoses. In the first case, the patient was unsteady upon standing, walked slowly and cautiously, and was diagnoses with multiple sclerosis. After her walking worsened, and she reported difficulty walking in open spaces and complained about "freezing up." She continued to experience falls backward, and stiff person syndrome was eventually affirmed.
In the second case, gait unsteadiness was prevalent, as the patient experienced spasticity in her legs with clonus as well as axial rigidity. The patient experienced frequent spasms and falls, and paraneoplastic syndrome and Pick's disease were considered. She suffered multiple lacerations, wrist and rib fractures, pneumothorax, and at one point she struck a building while driving a car. Her falls were likened to a "toy soldier or tree falling over," as she made no attempt to catch herself. Again, stiff person syndrome was eventually diagnosed.
Stiff person syndrome is an extremely rare condition affecting more women than men. By 1990, only about 100 cases had been reported worldwide, according to the article. SPS typically begins with a combination of muscle rigidity and intermittent spasms. Thoracolumbar paraspinal muscles and proximal leg muscles are principally affected, according to the article. The gait becomes stiff and slow, with symptoms typically beginning in the fourth the sixth decade.
Dr. Xu said co-authoring the article helped her expand her view on clinical cases. "This experience really made me think about clinical cases in a 3D dimension," she commented. "It definitely will make me a better clinician in the future."
Dr. Xu will begin a rheumatology fellowship next year at Baylor University.
Internal Medicine PGY3 Min Xu, MD recently co-authored an article in the journal South Dakota Medicine.