12322 Unraveling The Complexity Of Stiff-Person Syndrome: A Case Of Ozempic-Induced Gastric Paralysis In A Patient With Comorbid Type 2 Diabetes Mellitus

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Abstract

Abstract Disclosure: L.E. Igburuke: None. P. Tawde: None. V. Oparaocha: None. M.H. Horani: None. Y. Salim: None. M. Salim: None. O. Salim: None. Stiff-Person Syndrome (SPS) is a rare neurological disorder characterized by persistent muscle stiffness and spasms, often triggered by emotional or physical stress. The condition, predominantly affecting adults with a slight female preponderance, is believed to result from autoimmune mechanisms targeting glutamic acid decarboxylase (GAD). Treatment usually involves symptomatic relief with medications like benzodiazepines, while immunomodulatory therapies are considered for refractory cases. Despite its low prevalence, SPS is noteworthy due to its association with autoimmune conditions. The clinical landscape of SPS is complicated by its link to gastrointestinal dysmotility, stemming from dysregulation in GABAergic pathways. Patients with SPS are predisposed to gastrointestinal issues, which can be exacerbated by certain medications, such as glucagon-like peptide-1 (GLP-1) receptor agonists like Ozempic (semaglutide). GLP-1 receptor agonists, although effective for managing type 2 diabetes, can rarely cause severe gastrointestinal complications, including gastric paralysis. This report details a case of a 55-year-old male with SPS and type 2 diabetes mellitus who developed gastric paralysis following Ozempic therapy. The patient presented with progressive muscle stiffness and spasms over six months, with a history of type 2 diabetes and hypertension. Despite treatment with diazepam and gabapentin, his symptoms persisted, leading to the addition of Ozempic. Shortly after starting Ozempic, he experienced severe gastrointestinal symptoms, including nausea, vomiting, and abdominal distension. Gastric paralysis was confirmed through gastric emptying studies and esophagogastroduodenoscopy. Despite stopping Ozempic and supportive care, the patient required prolonged hospitalization. Gradual improvement in gastric motility was observed, and the patient was eventually discharged with ongoing management of SPS and diabetes. This case highlights the diagnostic and therapeutic challenges in managing SPS, particularly with comorbidities like type 2 diabetes. While GLP-1 receptor agonists are beneficial for diabetes management, they can lead to severe gastrointestinal issues, especially in patients with underlying neurological conditions. Clinicians should carefully consider the risk of gastrointestinal complications when prescribing GLP-1 receptor agonists and monitor patients closely to optimize outcome. Presentation: 6/1/2024