{
  "abstract": "Background Stiff-person spectrum disorder (SPSD) is a rare autoimmune neurological disorder characterised by progressive rigidity, muscle co‐contractions and spasms; 5%–10% are paraneoplastic. Few infection-related SPSD cases have been reported.Case presentation We describe a 56-year-old woman who developed SPSD after herpes zoster. Eight days after rash onset, she experienced persistent lower-limb tonic spasms with co‐contractions, autonomic symptoms and elevated anti-glutamic acid decarboxylase antibodies in serum and cerebrospinal fluid. Immunotherapy with repeated high-dose intravenous immunoglobulin and methylprednisolone pulses, along with continuous benzodiazepines and epidural analgesia, led to gradual improvement over 3 months.Conclusions Pain from herpes zoster may have amplified muscle co-contractions via withdrawal and crossed extension reflexes, exacerbating impaired reciprocal inhibition in SPSD. Clinicians should consider optimal pain control in addition to immunotherapy for SPSD triggered by infection.",
  "authors": [
    {
      "affiliations": [
        "Department of Neurology, Tsuchiura Kyodo General Hospital, Ibaraki, Japan"
      ],
      "name": "Sawako Sakai"
    },
    {
      "affiliations": [
        "Department of Neurology, Tsuchiura Kyodo General Hospital, Ibaraki, Japan"
      ],
      "name": "Mitsuki Kyoya"
    },
    {
      "affiliations": [
        "Department of Neurology, Tsuchiura Kyodo General Hospital, Ibaraki, Japan"
      ],
      "name": "Yuki Kobayashi"
    },
    {
      "affiliations": [
        "Department of Neurology, Tsuchiura Kyodo General Hospital, Ibaraki, Japan"
      ],
      "name": "Rika Nohara"
    },
    {
      "affiliations": [
        "Department of Neurology, Tsuchiura Kyodo General Hospital, Ibaraki, Japan"
      ],
      "name": "Naoki Yamagata"
    },
    {
      "affiliations": [
        "Department of Acute Critical Care Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan"
      ],
      "name": "Tomohiro Akutsu"
    },
    {
      "affiliations": [
        "Department of Neurology, Tsuchiura Kyodo General Hospital, Ibaraki, Japan"
      ],
      "name": "Akira Machida"
    }
  ],
  "title": "Stiff-person spectrum disorder induced by shingles: a case report",
  "uid": "77d83c35-7fd3-553c-873f-fea0197af533"
}