INTRODUCTION Camptocormia is characterised by extreme flexion of the thoracolumbar spine. It suffered an increase during walking and it is relieved in supine position. Camptocormia has been described in psychogenic disorders, but in other diseases, including Parkinson’s disease as well. It has been recently described several cases with focal spinal myopathy, and we present a patient with this clinical association.

CASE REPORT This 82-year-old man had a 6-year history of parkinsonian symptoms, mostly of rigid-akinetic type. He was in stage 4 on Hoehn & Yahr scale, and he had reached 62 points on Unified Parkinson Disease Rating Scale. Over the past 6-8 months, he developed progressive forward flexion of the trunk with clinical features of camptocormia. He suffered flogotic symptoms and signs on her lower back, and there were no dystonic posture or clinical features. Lumbar computerised tomography showed fat replacement of the paravertebral L3 muscles. A surgical paravertebral muscle examination and biopsy were performed, showing diffuse fat replacement and only a marginal myopathic focus. It was made several therapeutic approaches, with levodopa dose increase, reduction, fractioning, and addition of dopa-agonists. All of these strategies failed. It was determined to try a steroid course, but there were no improvement, so physiotherapy and rehabilitation measures did. He finally was confined to wheelchair.

CONCLUSIONS Physiopathologic and therapeutic aspects of camptocormia in Parkinson’s disease are unclear. Their relationship could be casual or causal. Patients with clear inflammatory myopathy could benefit from steroid therapy, but patients with end-stage myopathy probably do not so.

Introducción La camptocormia es un trastorno caracterizado por una postura anormal en flexión pronunciada del tronco, que desaparece al tumbarse y empeora al caminar; es de etiología diversa. Desde las consideraciones iniciales como trastorno psicogénico, se reconoce ya como un trastorno postural característico de la enfermedad de Parkinson, y se han descrito algunos casos en relación con miopatías focales lumbares. Presentamos un paciente con esta asociación clínica.

Caso clínico Varón de 82 años con parkinsonismo rígido-acinético de seis años de evolución, en estadio 4 de la escala de Hoehn y Yahr, y 62 puntos en la Unified Parkinson Disease Rating Scale. En 6-8 meses, desarrolló progresivamente una camptocormia dolorosa, sin datos de distonía asociados, y con signos flogóticos dorsolumbares. La tomografía axial computarizada lumbar mostró atrofia de los músculos espinales y sustitución grasa. La biopsia de músculos paraespinales mostró degeneración grasa y algún foco miopático marginal. Tras modificaciones infructuosas de su medicación dopaminérgica (incremento, disminución, fraccionamiento, agonistas dopaminérgicos), se realizó ciclo de tratamiento esteroideo por vía oral, sin observarse mejoría alguna. Tampoco mejoró con rehabilitación o fisioterapia, y quedó confinado a una silla de ruedas.

Conclusiones Los aspectos fisiopatológicos y terapéuticos en la camptocormia con miopatía focal asociada a la enfermedad de Parkinson son poco claros, y pueden relacionarse de modo causal o casual. Los pacientes con clara miopatía inflamatoria podrían beneficiarse de terapia esteroidea precozmente, pero no aquellos con estadios finales de miopatía focal espinal.