Rare infections mimicking MS
Vesna V. Brinar, Mario Habek
Received 28 March 2010; accepted 6 April 2010.
The diagnosis of multiple sclerosis (MS), despite well defined clinical criteria is not always simple. On many occasions it is difficult to differentiate MS from various non-MS idiopathic demyelinating disorders, specific and infectious inflammatory diseases or non-inflammatory demyelinating diseases. Clinicians should be aware of various clinical and MRI “red flags” that may point to the other diagnosis and demand further diagnostic evaluation. It is generally accepted that atypical clinical symptoms or atypical neuroimaging signs determine necessity for broad differential diagnostic work up. Of the infectious diseases that are most commonly mistaken for MS the clinician should take into account Whipple's disease, Lyme disease, Syphilis, HIV/AIDS, Brucellosis, HHV-6 infection, Hepatitis C, Mycoplasma and Creutzfeld-Jacob disease, among others. Cat scratch disease caused by Bartonella hensellae, Mediterranean spotted fever caused by Riketssia connore and Leptospirosis caused by different Leptospira serovars rarely cause focal neurological deficit and demyelinating MRI changes similar to MS. When atypical clinical and neuroimaging presentations are present, serology on rare infectious diseases that may mimic MS may be warranted. This review will focus on the infectious diseases mimicking MS with presentation of rare illustrative cases.
This week CALDA blog posted here the San Jose Mercury News writes a follow-up story on Bart Fenolio, who last December was told he had two months to live. Fenolio has been in a nursing home since then, receiving Lyme treatment. Now he's well enough to go home.
Told he was dying of ALS, California man turns it around with Lyme treatment.
Many patients with Lyme Disease will already have heard about Dr Martz who in 2003 was also diagnosed with ALS Upper and lower known as Motor Neurons here in the UK. He found that infact he had Lyme Disease and on appropriate antibiotic treatment turned his life around, more details can be seen on CALDA blog here and on Can Lyme here
In June 2010 ILADS held their first conference in London and I was privileged to be asked to help out at reception. I was able to listen to some of the presentations all really amazing and ground breaking work. Dr Martz had travelled from USA to join other Lyme Doctors from USA, UK, Germany and France.
I had a particular interest in hearing Dr Martz' presentation because someone I know of locally had like me been diagnosed years before with Polymyalgia Rheumatica and I had passed a message on when my Polymyalgia Rheumatica had been found to be Lyme Disease to perhaps check it out. More recently this person developed Neurological symptoms and was diagnosed with Parkinson's. It transpired that he had history of tick bite, had worked in agriculture and had a rash on his shoulder that had been there a year and had mystified his doctors. I heard this week that he has in fact tested positive for Lyme Disease so fingers crossed that his antibiotic treatment will go some way to alleviate his symptoms.
Dr Martz at the ILADS conference not only talked about his experience but also about his findings from treating other patients with such illnesses as ALS/Motor Neurons, Parkinson's and Multiple Sclerosis after his recovery he had come out of retirement and opened a clinic treating patients with Lyme Disease. This is clearly just the start of researching into these illnesses and Borrelia or Lyme Disease as one of their possible causes. Sadly with the controversy caused by IDSA restrictive Guidelines and the tests not being very reliable most people will not be properly assessed to see if their Multiple Sclerosis, Parkinson's or Motor Neurons could be Lyme Disease.
After the London ILADS conference and at the end of a very tiring day I watched Dr Martz and his lovely wife walk away through Regents Park and thought what an amazing man, no one would ever have thought that just 7 years ago he had been given a death sentence.