MS and Ulcerative Colitis

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This article documents that MS and Ulcerative Colitis can co-exist.

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LETTER TO EDITOR

Year : 2004 | Volume : 52 | Issue : 2 | Page : 282--283

Multiple sclerosis in a patient with chronic ulcerative colitis

Pandian JD, Pawar G, Singh GS, Abraham R

Departments of Neurology, Christian Medical College and Hospital,

Ludhiana, Punjab - 141008

Abstract

Pandian JD, Pawar G, Singh GS, Abraham R. Multiple sclerosis in a

patient with chronic ulcerative colitis.Neurol India 2004;52:282-

283

Full Text

Sir, We report a patient with chronic ulcerative colitis who

developed multiple sclerosis after 5 years of remission from

ulcerative colitis. A 34-year-old lady had recurrent bouts of loose

stools mixed with blood and mucus for 8 years and a non-healing

ulcer on the lateral aspect of left leg. Investigations revealed

ulcerative colitis. Skin biopsy revealed features of pyoderma

gangrenosum. She was treated with prednisolone and 5-aminosalicylate

following which there was improvement in colonic symptoms and the

ulcer over the leg healed. Five years after the treatment the

patient complained of diminution of vision in both eyes and pain in

the orbit on eye movements for 5 days. She was treated with oral

prednisolone and showed significant recovery. Three months later,

she developed weakness in both lower limbs over 6 days. She was

treated with oral steroids and her symptoms ameliorated in 2 weeks.

One month after recovery, she was readmitted with complaints of

progressive weakness and heaviness in the left upper and lower limb

for 15 days. Neurological examination revealed a visual acuity of

6/9 in both eyes and a relative afferent pupillary defect in the

left eye. Pronator drift could be elicited in the left upper limb;

in the left lower limb the power was Grade 4/5. The deep tendon

jerks were Grade 3 in the upper limbs and Grade 4 in the lower limbs

bilaterally. Spasticity was demonstrable in the left side with

extensor plantar response. MRI brain showed white matter lesions

[Figure:1]a and [Figure:1]b. Visual evoked potential was abnormal in

both sides. Cerebrospinal fluid (CSF) findings were as follows:

cells were absent; proteins were raised (74 mgms%) with normal

sugar. CSF-albumin 2 mgs/dl (13.6 - 34.6 mg/dl), IgG 19.6mgs/dl (1.7-

4.4 mg/dl), serum IgG 1722 mgs/dl (1000 - 2000mgs/dl) and serum

albumin 3.8 gms/dl (3.5 -8gm/dl). The CSF IgG level was greater than

12% of the total protein (26.4%). CSF electrophoresis revealed

decreased albumin, 35.57% (53.5 - 70.2%) and b1 globulins - 1.89%

(5.1-11.4%). She received a course of methyl prednisolone followed

by oral prednisolone for 21 days. At 2 years follow-up the patient's

visual acuity was normal and there was marked improvement in the

power of all the four limbs. The various neurological manifestations

of ulcerative colitis reported in the literature are myelopathy,

peripheral neuropathy, myopathy, cerebral venous thrombosis,

cerebrovascular disease and myasthenia gravis.[1] There are reports

about the association between multiple sclerosis and inflammatory

bowel disease.[2],[3],[4] Twenty-seven instances of familial

concurrence were identified from British Columbia.[4] In another

series from Alberta, 17 instances of familial concurrence of both

disorders were ascertained.[5] The family history in our patient

didn't reveal any such familial association of two disorders.

Familial concurrence of inflammatory bowel disease and multiple

sclerosis may represent shared genetic or environmental causes.[5]

Sadovnick and his co-investigators postulated that one or more loci

contributing specifically to inflammatory bowel disease may also

determine susceptibility to multiple sclerosis.[4] Multiple

sclerosis and inflammatory bowel disease share common predisposing

factors, but not enough information is available to speculate about

possible mechanisms.

References

1 Lossos A, River Y, Eliamkim A, Steiner I. Neurological aspects of

inflammatory bowel disease. Neurology 1995;45:416-21.

2 Rang EH, BN, JH. Association of Ulcerative Colitis

with Multiple Sclerosis. Lancet 1982;2:555.

3 Kimura K, Hunter SF, Thollander MS, et al. Concurrence of

Inflammatory Bowel disease and Multiple Sclerosis. Mayo Clin Proc

2000;75:802-6.

4 Sadovnick AD, Paty DW, Yannakoulias G. Concurrence of Multiple

Sclerosis and Inflammatory bowel disease. N Engl J Med 1989;321:762-

3.

5 Minuk GY, Lewkonia RM. Possible Familial association of Multiple

Sclerosis and Inflammatory Bowel disease. N Engl J Med

1986;314:586.