Several autoimmune diseases can cause demyelination in the central nervous system. This may mimic multiple sclerosis, and both autoimmune disease and multiple sclerosis can co-exist.
Autoimmune diseases associated with demyelination:
(1) systemic lupus erythematosus
(2) antiphospholipid syndrome
(3) Sjogren's syndrome
(4) Behcet's disease
Neurological symptoms and imaging studies may overlap between autoimmune demyelination and multiple sclerosis.
Features associated with the autoimmune disease:
(1) high titers of autoantibodies
(2) involvement of organs outside of the brain
Features associated with multiple sclerosis:
(1) abnormal CSF IgG production
(2) usually < 50 leukocytes per µL in the CSF
Problems in diagnosis:
(1) onset of neurologic symptoms prior to other manifestations of the autoimmune disease or the appearance of diagnostic autoantibodies
(2) low titers of autoantibodies in a patient with multiple sclerosis
