A case of Sjögren's syndrome or multiple sclerosis? A diagnostic and therapeutic dilemma.
BACKGROUND
Primary Sjögren's syndrome (SS) with central nervous system involvement and antiphospholipid syndrome have been reported to mimic multiple sclerosis (MS). SS has also been found in patients diagnosed with definite MS.


METHODS
A Chinese lady developed multiple relapsing neurological events involving the brain and spinal cord from the age of 40 years. Magnetic resonance imaging of the brain and spinal cord during acute relapses showed increased T2 signals and spinal cord edema. She later developed positive anti-nuclear antibody and anti-Ro autoantibody followed by sicca symptoms, confirming the diagnosis of SS. She died from aspiration pneumonia following pseudobulbar palsy shortly after SS was diagnosed.


CONCLUSIONS
Patients with MS-like disease and autoantibodies should be carefully evaluated for other systemic autoimmune diseases as the treatment and prognosis differ from MS. In particular, sicca symptoms should be sought as they often go unnoticed by patients. This is especially important in Orientals in whom MS is relatively uncommon.
Thong
Bernard Yu-Hor
BY
Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore. bernard_thong@ttsh.com.sg
Venketasubramanian
N
N
D000328:Adult; D000974:Antibodies, Antinuclear / Q000097:blood; D002490:Central Nervous System / Q000473:pathology; D002681:China / Q000208:ethnology; D003937:Diagnosis, Differential; D004487:Edema / Q000209:etiology / Q000473:pathology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D009103:Multiple Sclerosis / Q000208:ethnology / Q000276:immunology / Q000473:pathology*; D012846:Singapore / Q000453:epidemiology; D012859:Sjogren's Syndrome / Q000097:blood / Q000150:complications / Q000473:pathology*
D000974:Antibodies, Antinuclear; C035356:SS-A antibodies