Shakour Rebecca L, Tascione Oriana, Carberry Nathan, Flores-Gonzalez Ramon
Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA.
Department of Neurology, Yale School of Medicine, New Haven, CT, USA.
J Med Cases. 2024 Dec;15(12):387-395. doi: 10.14740/jmc4336. Epub 2024 Oct 30.
Evaluating patients with symptoms suggestive of demyelinating disease such as multiple sclerosis (MS) is common in both the inpatient and outpatient setting but may be difficult if atypical neurological symptoms are present. In this case, a 39-year-old female presented with new onset weakness and paresthesias. The patient reported 3 weeks of progressively worsening left face and hemibody numbness, along with gait abnormality. She was found to have absent lower extremity reflexes, unexpected imaging findings, and a positive anti-Sjogren's syndrome type B (SSB) antibody despite lacking the typical sicca symptoms associated with Sjogren's syndrome (SS). This case report underscores the diagnostic complexity of overlapping MS and SS, highlighting the need for a comprehensive differential diagnosis when atypical neurological symptoms are present. It also emphasizes the importance of considering autoimmune overlap syndromes in such cases, as the co-occurrence of these conditions can significantly impact both diagnosis and treatment strategies, requiring a multidisciplinary approach for optimal patient care.
评估有脱髓鞘疾病症状（如多发性硬化症（MS））的患者在住院和门诊环境中都很常见，但如果存在非典型神经症状，可能会很困难。在这个病例中，一名39岁女性出现了新发的无力和感觉异常。患者报告了3周来逐渐加重的左侧面部和半身麻木，以及步态异常。她被发现下肢反射消失，有意外的影像学表现，并且尽管缺乏与干燥综合征（SS）相关的典型干燥症状，但抗干燥综合征B型（SSB）抗体呈阳性。本病例报告强调了MS和SS重叠的诊断复杂性，突出了存在非典型神经症状时进行全面鉴别诊断的必要性。它还强调了在此类病例中考虑自身免疫重叠综合征的重要性，因为这些疾病的同时出现会显著影响诊断和治疗策略，需要多学科方法来实现最佳的患者护理。
