Abstract
Background
Rare and poorly understood, Painful legs and moving toes (PLMTS)manifests as abnormal movements of the toes and moderate to severe leg and foot pain. The exact underlying pathophysiology is not clear. Its incidence is unknown. Here, we report a female patient that was initially misdiagnosed with Sjogren's syndrome by a rheumatologist, but eventually correctly diagnosed with Anti-hu antibody positive paraneoplastic syndrome.
Case presentation:
A 66-year-old female suffered from severe pain in both lower limbs for three months, accompanied by involuntary and irregular movements in her ankles and feet. She also complained of dry mouth. She was initially diagnosed with painful leg and moving toes syndrome provoked by Sjögren's syndrome-related peripheral neuropathy and received corticosteroid pulse therapy. However, the patient's symptoms continued to worsen over time.Follow-up examinations revealed that the patient had anti-Hu antibody IgG positivity in both her blood and cerebrospinal fluid samples, together with a tumor in the right ovary. The patient then underwent regular chemotherapy for ovarian cancer and her neurological symptoms were partially relieved during the follow-up. In our case, electroencephalography and brain MRI all revealed unremarkable findings: in clinical practice, this could lead to misdiagnosis with psychogenic conditions. Our patient was almost misdiagnosed as primary Sjogren’s syndrome by a rheumatologist as well. Consequently, we consider that clinicians should be aware of this unique disorder in order to avoid misdiagnosis.
Conclusion
PLMTS can be seen in anti-hu antibody positive paraneoplastic syndrome.