A diagnosis after the age of 50 necessitates additional tests. Finally, she was able to walk without any difficulty or anxiety. Turner syndrome can be diagnosed during fetal life, in infancy, during the late pre-teen period (8-12 years), or in late adolescence/early adulthood. However, after the SPS diagnosis was made, she was given plasma exchange and intravenous immune globulin, and subsequently commenced on oral diazepam, which was tapered gradually. Initially, under the tentative diagnosis of NMS, the patient had not showed any improvement with SSRI cessation and intravenous dantrium. These findings led to the final diagnosis of stiff-person syndrome (SPS). Blood tests revealed an extremely high level (>2000 U/mL) of antiglutamic acid decarboxylase antibodies, and her cerebrospinal fluid contained oligoclonal bands. Physical examination revealed severe lumbar lordosis and muscle stiffness in her lower limbs, bilaterally ( video 1). As she was on a selective serotonin reuptake inhibitor (SSRI) regimen and had a fever, diaphoresis and elevated serum creatine kinase (CK) (16 200 U/L), a working diagnosis of neuroleptic malignant syndrome (NMS) complicated by rhabdomyolysis was made, necessitating referral to our care facility for further examination. She was alert, although episodic spasms were induced repeatedly by sudden touch, noise and light. She became shut-in due to fear of falling and being unable to walk without using a cane. The sudden stiffness had worsened and resulted in multiple falls 3 years before admission. A 52-year-old woman presented with episodic stiffening of her back and thighs every 3 months for 5 years.
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