Международный журнал физической медицины и реабилитации
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A Curiously Unusual Cause for Weakness in a Geriatric Patient

Mercedes Malone, Nannette Hoffman, Christopher Bray, Brittnay Puebla, David Rtichie

Lower extremity weakness with reversible or medical etiologies is sometimes overlooked in the elderly patient. There are various causes of increased falls and weakness in the elderly population. Some causes of increased falls vision disturbances, impaired balance due to otolith dysfunction, arthritic-related immobility and lower extremity
neuropathy. Clinicians should consider rarer neurological etiologies such as Guillain-Barre and transverse myelitis as part of the differential diagnosis.

We present a complex patient case with multiple admissions for progressive weakness and falls without a clear etiology. This patient case presented a diagnostic challenge and eventually no unifying diagnosis was causative. The patient had various diagnostic tests suggestive of occult infection from Lyme disease serology, tuberculosis, Propionibacterium acnes and stool campylobacteriosis. Patient also had a remote history of a gastrointestinal tract neuroendocrine tumor in remission following surgical resection. All these conditions were considered in the differential diagnosis and treated accordingly without symptom improvement. The patient completed Intravenous Immunoglobulin (IVIG), antibiotics, anti-inflammatory and antiviral medications without clinical response. Eventually the patient opted for hospice and palliative care rather than continuing other therapeutic options.

This complex case highlights the difficulty in establishing precipitating factors in falls within the elderly population. While many falls are triggered by weakness simply due to muscle-related-atrophy and age related inactivity, this is not always the case. There are pathologies that are reversible and treatable and it is important to identify these conditions
early on and provide prompt treatment.