How I became aware of this rare disease

I was on call when a woman entered my office and told me she had an emergency.
She brought her husband, a 50 year old man, postrated, with infected pressure wounds on his back, a septic look on his face.
I gave him a thorough look only to realize that he was spastic, he could not move his limbs. The only movement I could discerns was the tremor of his hands and head.
At first glace, I thought he was a stroke patient or a patient suffering from Parkinson.
A complete clinical assessment showed the following:
BP 100/60mmHg (when I tried to sit him up with his legs hanging, BP dropped more than 20 mmHg) HR 98bpm RR 29rpm Temp 36,5 (celsius)
He was lying on his back, had a diaper on with urine a fecal matter.
He looked dehydrated
Pale, dry skin, infected pressure wound on his back, an anaerobic bacteria smell came from the wound.
His face wore an inexpressive look.
On his cardiac and respiratory examination rales could be heard on both lungs.
Abdominal examination didn't show any abnormalities.
His limbs were shaky but when an active maneuver was performed, his muscles were stiff, he had areflexia.
Neurological examination showed dementia, many extrapiramidal symptoms such as tremor, and ataxia.
I diagnosed a Parkinson like syndrome and then reviewed the diagnostic possibilities on the net. I found some rare syndromes that could be associated with this symptoms: Shy Drager Syndrome (SDS) and Multiple System Atrophy (MSA). Later I foud out that they were related.
I started treatment with antibiotics and he could be discharged but later that month he died from a massive aspiration of gastric content to his lungs.
The autopsy revealed the typical histological findings of SDS.

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