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Background  Disorders of oxidative phosphorylation affects 1/5000 individuals and present heterogeneous involvement of tissues highly dependent upon ATP production.    Case presentation  Here we present the case of a 48-year-old woman carrying a homozygous mutation (p.A899T) in mitochondrial polymerase gamma ( POLG ) and manifesting with a complex neurological phenotype including Dopamine-agonist responsive Parkinsonism.    Conclusion  This case report is further evidence that mitochondrial dysfunction might play a role in Parkinson’s Disease pathogenesis and helps in identification of apparent mutation-specific clinical characteristics. Mutations in  POLG  should be looked for in cases of Parkinsonism, especially when multisystem neurological involvement is found.

Dopamine-agonist responsive Parkinsonism in a patient with the SANDO syndrome caused by POLG mutation