Stiffman syndrome combined with latent autoimmune diabetes in adults: a case report with literature review

Objective To summarize the clinical features in a case of stiffman syndrome combined with latent autoimmune diabetes in adults (LADA). Methods A 61-year old male patient who presented with progressive trunk muscle stiffness, ankylosis and paroxysmal painful spasm for 3 years was admitted to hospital in April 2016. He was diagnosed with type 2 diabetes 2 years prior and initially stabilized by oral medicine of metformin and acarbose. His fasting plasma glucose (FPG) was 15.29 mmol/L, glycosylated hemoglobin (HbA1c) was 10.60%, glutamic acid decarboxylase antibody (GADA) was 39.0 mU/L, thyroid globulin (TG) antibody was 1 044 mU/L and he presented with absolute insulin deficiency. Results Clonazepam and baclofen were used to relieve muscle stiffness. After insulin treatment for 3 months, the patient's HbA1c was 7.4%, GADA was 36.4 mU/L, TG antibody was 1 068 mU/L and insulin deficiency was persistant. Literature review revealed that GADA was involved in the pathogenesis of LADA, stiffman syndrome, thyroiditis and other autoimmune diseases. Conclusion The result shows extremely high titers of GADA can trigger multiple autoimmune antigen and result in stiffman syndrome, LADA concomitant with other autoimmune diseases. It is recommended that diabetic patients with neurological symptoms should be screened for islet autoantibodies to identify the types of the disease and guide treatment. Key words: Stiffman syndrome; Latent autoimmune diabetes in adults; Glutamic acid decarboxylase antibody