A 29-year-old Nigerian Edo woman, presented with a five-day history of tremor of her fingers and head at rest, with associated drooling of saliva from her mouth. There was no history of fever, vomiting, headache, dyspeptic symptoms, or any other neurological symptoms, although she reported dizziness. She had not used any drugs in the preceding six weeks except for quinine tablets. She reported having had amenorrhea for eight weeks, and believing she was pregnant, she took some quinine tablets to terminate the pregnancy. She reported having vaginal bleeding five days after ingestion of six tablets of quinine. She had no family history of PD. On physical examination, our patient was found to have mask-like facies, and her speech was monotonous and slightly slurred. She was extremely slow in carrying out all motor activities. Results of neurological examinations were essentially normal except for the presence of cogwheel and global muscular rigidity.
Based on the clinical signs and symptoms, a diagnosis of drug-induced Parkinsonian syndrome was made. The patient was started with low-dose levodopa/carbidopa 100/25 mg tablets twice daily. After five days of treatment, all the symptoms disappeared.
Results
b) Quinine
Quinine is a anti- malarial drug. Quinine decreases the level of dopamine in the striatum and nucleus accumbens and showed a similar tendency in the substantia nigra and frontal cortex. It also causes ataxia, tremor, and dystonic reactions leading to parkinsonism.
