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JAMA Neurology Clinical Challenge
July 15, 2019

A Case of Muscle Twitching With Psoriasis

Author Affiliations
  • 1Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
  • 2Department of Medicine, University of Massachusetts Medical School, Worcester
JAMA Neurol. 2019;76(9):1119-1120. doi:10.1001/jamaneurol.2019.1937

A 42-year-old man presented with a 2-month history of persistent muscle twitching in his abdomen and bilateral calves during wakefulness and sleep accompanied with excessive sweating, as well as mild bilateral lower extremity weakness after prolonged walking. The patient denied confusion, memory problems, hallucinations, and sleep disturbance. He had psoriasis for 30 years, for which he was taking steroids intermittently, and hypothyroidism for 4 years, for which he was taking levothyroxine. His family history was unremarkable. His examination results were significant for psoriatic skin lesions and purple stria in the abdomen and both calves. Undulating wavelike movements were visible on the muscle surface of the abdomen and calves (Video). The remaining general and neurological examination results were normal. Laboratory test results, including creatine kinase, thyrotropin, antinuclear antibodies, paraneoplastic antibodies (includes Hu, Yo, Ri, CV2, Ma2, and amphiphysin antibodies), were normal. Chest computed tomography results were normal.

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