Drug-induced movement disorders: sulfasalazine-associated chorea
Introduction (case reports only) Introduction. Chorea is a hyperkinetic movement disorder characterized by involuntary, brief, non-rhythmic movements. Late adult-onset chorea is rare: less than 0.3 % of the patients are over 55 years old. In most cases, chorea may be caused by hereditary neurodegenerative diseases, autoimmune disorders, metabolic derangement, hormones or certain drugs. We report a case of chorea in a patient under sulfasalazine treatment for ankylosing spondylitis. Neurotoxicity secondary to sulfasalazine was suspected. Case description (case reports only) Case description. A 64 years old man complains of involuntary movements, grimacing lasting for several months. Patient took these medications due to chronic illnesses: trihexyphenidyl, trimetazidine, vinpocetine, domperidone, nebivolol, monoxidine, aspirin, perindopril, rosuvastatin, perindopril arginine/indapamide/amlodipine, tardyferon, mildronate, sulfasalazine (500 mg twice a day for several months). Neurological examination showed involuntary movements with blowing cheeks, grimacing, dysarthria. Blood tests: everything was in normal reference range. No signs of abnormalities were dectected in brain CT and MRI scans. Secondary chorea was suspected as a side effect of medications. The patient was consulted by a clinical pharmacologist: it was clarified that patient wasn‘t taking antipsychotic drugs, drugs against parkinsonism and there was no history of movement disorder or psychiatric illness. Dyskinesia can be caused by sulfasalazine, domperidone, trimetazidine – discontinuation of these medications was recommended. After suspending sulfasalazine and trihexyphenidyl patient‘s condition improved, the neurological deficit regressed. Summary (case reports only) Summary. 64 years old male was admitted to hospital because of abnormal involuntary movements. After thorough diagnostics patient was diagnosed with secondary chorea due side effect of sulfasalazine. After suspending medication, male‘s neurological status improved. Conclusions Conclusions. Polypharmacy in the elderly is actual problem. It could be as a potential etiology of hyperkinetic movement disorders. In clinical practice it is important to identify this when other possible causes are excluded.