Coexistence of multiple sclerosis and systemic lupus erythematosus - a case report

Abstract

Purpose: Multiple sclerosis (MS) and systemic lupus erythematosus (SLE) are two autoimmune diseases that are relatively common, especially in women. However, it is extremely rare for them to coexist in a single patient (only 18 cases have been recorded worldwide). Both affect the nervous system and may manifest in identical ways. This creates significant difficulties, both in terms of diagnosis and choice of appropriate therapy.

Case description: A 54-year-old female patient with quadriparesis, superficial sensory disturbance and gait and balance disorders was diagnosed with primary progressive MS according to McDonald's criteria. The magnetic resonance images were typical for MS. Previously, in 2013, she was diagnosed with SLE, treated successfully, and is currently in remission. After excluding neuropsychiatric lupus, ocrelizumab treatment was administered, with good clinical results.

Comment: Adequate differentiation (magnetic resonance imaging, analysis of cerebrospinal fluid, clinical observation) as to whether the patient's symptoms are related to MS or to SLE nervous system involvement is the basis for proper diagnosis and treatment.

Keywords: coexistent disease; differential diagnosis; multiple sclerosis; systemic lupus erythematosus.

Figure I

A) Magnetic resonance imaging (MRI) scan of the brain in T2-weighted image in FLAIR sequence, (B) axial plane, (C) MRI scans of the brain in T2-weighted image, sagittal plane. Multiple sclerosis lesions according to Barkhof and Tintore MRI criteria for primary progressive multiple sclerosis [14]

Figure II

Magnetic resonance imaging scan of the spinal cord in T2-weighted image, sagittal plane. Multiple sclerosis lesions in the spinal cord (hyperintense areas)