[A case of acute cholinergic dysautonomia]

A 52-year-old man with hypohidrosis and selective parasympathetic peripheral autonomic nerve disturbances of acute onset is described. In April 1991, he noted a feeling of dryness in the eyes and the oral cavity, disturbance of taste, difficulty in micturition and a feeling of dryness at the distal extremities with acute onset, which were followed by alternating diarrhea and constipation. Clinical and laboratory autonomic examinations revealed decreased sweating in the distal extremities, decreased lacrimation and salivation, a decrease in the average urinary flow with residual urine and hypersensitive pupillary constriction to the instillation of methacholine. On the other hand, the results of upright tilt testing, the Valsalva test and cold pressor test were all normal, and the plasma noradrenaline level was also normal. Therefore, the diagnosis of acute cholinergic dysautonomia was made. He resumed his clerical work without medication 3 months after the onset. One year and 4 months after the onset, clinical and laboratory examinations showed that hypohidrosis in the distal lower extremities remained unchanged. We found ten patients of acute cholinergic dysautonomia in the literature, and concluded that our patient should be classified as a typical case of this disease. Clinical reports of acute cholinergic dysautonomia are relatively rare, and our patient is the oldest among the reported patients.