Multiple Sclerosis (MS) and Sarkoidosis one entity?

Multiple Sclerosis (MS) and Sarkoidosis one entity?

Background: The two illnesses MS and sarkoidosis appear to have several things in common. They both are autoimmune diseases affected by infectious agents and present relapsing and remitting MS affects the central nervous system while sarkoidosis is granulomatous a disease that among others parts attacks the nervous system also. The coexistence of the two diseases in one patient lends to the question whether the two diseases are in actuality one.

Case report: The patient is a female, 52 years old of age with a mild form of chronic MS first diagnosed 15 years ago. Within a period of months she appeared to have suffered from loss of weight, abdominal pain, fatigue, inability to walk, difficulty in breathing, ataxia, dysphasia and various aesthetic disturbances. The clinical examination showed dapple vision, horizontal nystagmous a mild spastic tetraparesis with babiski positive and scattered sensoric disturbances. Beyond that a pulmonary infiltration was found and palpably liver.

The clinical and neurological and neurophysiological examination confirmed the already known existence of MS. The liver tests showed an increase in transaneminase. Scanning with 6A ^60-67 showed granulomatous pulmonary infiltration with hilar lympadenopathy (lunges and liver biopsy alterations granulomatous of the sarkoidosis type). After treatment of immunosuppressive and intravenous immunoglobulines there was an improvement in the typical symptoms of both diseases.

Discussion: Neither MS nor sarkoidosis present problems in diagnosis as a rule. While the first attacks the CNS the second assaults various body parts. It may be however that due to the nature of the clinical picture, one may be hiding the other which makes diagnosis harder. However, the autoimmune origin, the sameness of the clinical behvour and the fact that the immunosupressive treatment generated a parallel improvement in the patients leads to the possibility of a unified entity of the two illneses.

This is however an observation that will require more research, and should make us have careful when diagnosis MS about the existence of more autoimmune problems.

paper presented at the EUROPEAN SOCIETY OF THORACIC IMAGING, 6^th Annual meeting, Bologna, Italy, June 14-16, 1998