Belly dancer syndrome induced by salbutamol

Abstract

A 54-year-old man with type 2 diabetes mellitus for 10 years on metformin 1 g two times per day and gliclazide 40 mg daily, and bronchial asthma for 30 years on metered-dose inhalers budesonide two puffs two times per day and salbutamol two puffs as required. There was no history of neuropsychiatry problems. He presented with sudden onset of frequent, intermittent, involuntary painless abdominal wall jerky movements. This occurred following usage of salbutamol metered-dose inhaler 1600 μg within half hour in the emergency department for asthma treatment. He was prescribed salbutamol inhalers instead of the usual nebulisers during the COVID-19 period. As his symptoms did not improve, he was subsequently given intravenous hydrocortisone 200 mg and intravenous magnesium sulfate 2.47 mmol/L. He developed signs of sympathetic hyperactivity as evidenced by diaphoresis, increased heart rate 130 beats per minute, blood pressure 140/98 mm Hg and respiratory rate 24 breaths per minute. On examination, these movements (video 1) represented belly dancer syndrome. During sleep and rest at night, the movements still persist but reduced. The movements resolved after his salbutamol inhalers were ceased on the third day of admission following improvement in his symptoms. There was no further recurrence of his abdominal movements. The MRI of the spine, electroencephalogram and chest radiograph were normal.