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CC BY 4.0 · Arq Neuropsiquiatr 2024; 82(S 01): S1-S52
DOI: 10.1055/s-0044-1789327
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Systemic autoimmunity in a multiple sclerosis patient: thyroid and liver overlap

Authors

  • Giuseppe Dick Bonato

    1   Pontifícia Universidade Católica do Rio Grande do Sul, Hospital São Lucas, Porto Alegre RS, Brazil.

  • Marcieli Gerhardt

    1   Pontifícia Universidade Católica do Rio Grande do Sul, Hospital São Lucas, Porto Alegre RS, Brazil.

  • Jefferson Becker

    1   Pontifícia Universidade Católica do Rio Grande do Sul, Hospital São Lucas, Porto Alegre RS, Brazil.
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Address for correspondence: Giuseppe Dick Bonato (email: g.d.bonato@hotmail.com).

Abstract

Case Presentation: We present the case of a 62-year-old female patient with multiple sclerosis (MS) and systemic autoimmunity syndrome. She was an outpatient in a tertiary neuroimmunology clinic and was also followed by rheumatology, dermatology, hepatology and endocrinology specialists. She presented trouble walking at age 53, developing sensory and weakness in her lower limbs in the following 4 years. There was no marked clinical attack. Cervical-thoracic MRI scans showed multiple short thoracic demyelinating lesions in the lateral and dorsal funiculi and corresponding volume reduction. Brain MRI scans showed periventricular, deep white matter, pons, medulla oblongata, cerebellar peduncles and cerebellar hemispheres lesions. She was diagnosed with primary progressive MS (PPMS) and is currently under treatment with ocrelizumab. At age 38, she was diagnosed with hypothyroidism, and a positive anti-TPO antibody enabled the establishment of the diagnosis of Hashimoto thyroiditis. Persistently high transaminases and biliary tract inflammation led to the diagnosis of autoimmune sclerosing cholangitis. Rheumatologic workup showed anti-mitochondria cytoplasmatic ANA 1:320, p-ANCA 1:80, and anti-mitochondria 1:160. She had type-3 oligoclonal banding. At her last clinical visit, the EDSS score was of 3.5 and the T25FW time was of 12 and 13 seconds. She presented trouble walking, urinary urge incontinence, lower limb sensory and motor deficits and multiple pyramidal signs.

Discussion: Autoimmunity markers are often seen in MS patients, as well as a strong correlation to other autoimmunity diseases. Some cases present a particularly complex challenge in differentiating between comorbidity and neurological manifestation of a systemic disease. Clinical features and radiological findings can help establish the diagnosis.

Final Comments: We presented an uncommon case of PPMS with systemic autoimmunity features. The complexity and frequency of other autoimmunity disorders make a high level of suspicion necessary. This case illustrates the importance of continuous multidisciplinary evaluation and follow-up.


No conflict of interest has been declared by the author(s).

Publication History

Article published online:
02 October 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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