Objective: We aim to emphasize the relevance of contemplating nonmotor symptoms as possible features of drug-induced parkinsonism, and the utmost importance of further investigation in this topic.

Background: Parkinson disease (PD) and drug-induced parkinsonism (DIP) have proven to be a challenge when attempting to clinical distinguish both, and the presence of nonmotor symptoms usually favours the diagnosis of the former. Although the literature regarding this matter is scarce, there is growing evidence of nonmotor symptoms in drug-induced parkinsonism.

Method: Case report – retrospective chart review.

Results: We hereby present the case of a 78-year-old feminine patient, with psychiatric comorbidity, namely depression 3and persecutory delirium, stable with long-term antipsychotic therapy with amissulpride. The patient underwent a neurology consultation for the first time in 2014, and a bilateral and symmetric akinetic-rigid parkinsonic syndrome was evident, without further associated symptoms. In the light of discontinuation of the antipsychotic therapy, the patient’s motor symptoms improved, but this pharmacological class of drugs had to be re-introduced in 2019, given the recurrence of the psychiatric symptoms. The patient was again consulted by a neurologist in 2020 and, on this occasion, hypomimia, bilateral cogwheel rigidity and parkinsonian gait, with small steps and diminished arm swing, was perceived. No rest or action tremor was evident, neither was postural instability. Along with that, the patient complained of profuse rhinorrhoea exclusively in the presence of food, which motivated observation by an otolaryngologist, who excluded local pathology. An attempt to taper the antipsychotic medication was performed, which resulted in a motor improvement with the cost of aggravation of the delusional symptoms. A trial with levodopa/carbidopa was undertaken, and an unsatisfactory response was achieved, although the gustatory rhinorrhoea perpetuated. DaTscan revealed normal dopaminergic activity, corroborating the clinical impression of drug-induced parkinsonism.

Conclusion: Gustatory rhinorrhoea, although a rare manifestation, has already been reported in association with PD. Up to this time and in the light of the authors knowledge, this is the first case-report of gustatory rhinorrhoea related to DIP.

References: Zubair U, Salam O, Zubair Z. Gustatory Rhinorrhea: A Rare Presentation of Parkinson’s Disease. Cureus. 2018;10(8). doi:10.7759/CUREUS.3224
Brigo F, Erro R, Marangi A, Bhatia K, Tinazzi M. Differentiating drug-induced parkinsonism from Parkinson’s disease: an update on non-motor symptoms and investigations. Parkinsonism Relat Disord. 2014;20(8):808-814. doi:10.1016/J.PARKRELDIS.2014.05.011
Zis P, Erro R, Walton CC, Sauerbier A, Chaudhuri KR. The range and nature of non-motor symptoms in drug-naive Parkinson’s disease patients: a state-of-the-art systematic review. npj Park Dis. 2015;1(1). doi:10.1038/NPJPARKD.2015.13

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MDS Abstracts - https://www.mdsabstracts.org/abstract/drug-induced-parkinsonism-and-nonmotor-symptoms-a-case-of-gustatory-rhinorrhea/