A challenging entity: multiple sclerosis or collagen tissue disorders: A case series of 6 patients

Abstract

Background: Multiple sclerosis and other demyelinating processes are sometimes difficult to differentiate from the neurological involvement in autoimmune diseases. Distinguishing multiple sclerosis from other lesions due to autoimmune diseases is crucial to avoid unsuitable or delayed treatments.

Methods: Charts of 6 patients diagnosed with mimicking multiple sclerosis between 1996 and 2014 were retrospectively assessed.

Results: The mean age at diagnosis was 35±7 years. The most commonly neurological manifestation at onset was paraparesis due to transverse myelopathy and uni/bilateral optic neuropathy. All our patients suffered from recurrent episodes of optic neuritis with a mean lag time of 12 months. Other initial presenting neurological manifestations in our patients included ataxic gait and pyramidal syndrome. Systemic symptoms occurred a long time before or after their initial neurological presentation. All patients had numerous T2 hyperintense lesions in the periventricular white matter and spinal cord with contrast enhancement. The antibodies tests revealed the presence of significant amounts of anti-nuclear antibodies. The anti-phospholipid antibodies were negative in all patients. All patients were treated with corticosteroid therapy and neurological features were cleared in all cases.

Conclusion: Multiple sclerosis, other myelitis and optic neuritis, are sometimes difficult to differentiate from CNS involvement in autoimmune disease. Indeed, the clinical presentation, immunological profile and MRI lesions may be similar.

Keywords: Autoimmunity; Collagen tissue disorders; Multiple sclerosis.

Figure 1

Cerebral and spinal MRI demonstrated isointensities on T1 weighted images, T2 hyperintensities extending from the 3^rd to the 9^th thoracic vertebrae with a strong enhancing Gadolinium signal

Figure 2

Cerebral MRI enclosed multiple T2 hyperintensities of brainstem, cerebellum, corpus collosum and periventricular white matter

Figure 3 (A, B).

Cerebral and spinal MRI demonstrated isointensities on T1 weighted images, T2 hyperintensities extending from the 3^rd to the 9^th thoracic vertebrae with a strong enhancing Gadolinium signal

Figure 4 (A, B).

The spinal cord MRI revealed else increased T2 signal extended from the 3^rd cervical vertebrae to the 10^th thoracic vertebra and from the 1^st lumbar to the 2^d lumbar vertebrae

Figure 5

The spinal cord MRI revealed T2-weighted images a homogeneous hyperintensity was found extending along the 1^st and 2^nd cervical vertebrae and demonstrated moderate gadolinium enhancement

Figure 6

Cerebral MRI showed multiple enhancing lesions of bulb, cerebellar peduncles and extensive to the cervical spinal cord