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Issue: Issue 3 (2016) – Supplement 3

Case Report

Autoimmune polyglandular syndrome: coincidental or multiple sclerosis mimic?

Ricardo Soares-dos-Reis, Carlos Andrade, Joana Oliveira, Paula Freitas, and Joana Guimarães
Introduction: Multiple sclerosis (MS) is an autoimmune disorder (AD) that has been associated with other ADs, such as thyroiditis. However, association with autoimmune polyglandular syndromes (APS) has seldom been described and some reports documented central nervous system (CNS) involvement by APG. 
Case Report: A 32-year-old female presented with acute, painful, unilateral vision loss. She had past medical history of follicular thyroid adenoma and lymphocytic thyroiditis, having undergone partial thyroidectomy, and diabetes mellitus type 1 (anti-GAD+), fulfilling criteria for APG type III. Her neurological examination was remarkable only for a right afferent pupillary defect. Laboratory tests showed cobalamin deficiency and positivity for anti-thyroid, anti-parietal celland anti-intrinsic factor antibodies. Anti-gliadin and anti-tissue transglutaminase antibodies were negative. Thyroid function, cortisol and adrenocorticotropic hormone (ACTH) levels were normal. Neuraxis MRI showed periventricular, juxtacortical and infratentorial white matter lesions and two small spinal lesions, all with no gadolinium enhancement. Cerebrospinal fluid analysis, including oligoclonal bands was unremarkable. Visual evocated potentials had bilaterally increased latency values. A course of intravenous corticosteroids was started and cobalamin was supplemented. No long-term treatment was initiated. During 2-year follow-up, no other relapse has been recorded and neuraxis MRI remains stable. 
Discussion: Few cases of APG have been described with inflammatory CNS involvement and/or MS. It is unclear whether there is concomitant occurrence of two ADs, or if there is a shared pathophysiology. Moreover, cobalamin deficiency is common in this condition, providing a potential cause for CNS disease. In this case, a watchful waiting approach was adopted.

Keywords: Multiple sclerosis, Autoimmune polyglandular syndrome.

Special Issue on Inflammatory Demyelinating Diseases of the Central Nervous System

International Journal of Clinical Neurosciences and Mental Health 2016; 3(Suppl. 3):S05 
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