Abstract
We report a 23-year-old woman who was a probable case of multiple sclerosis (MS) associated with insulin dependent diabetes (IDDM). She was diagnosed as having IDDM at 14 years of age and subsequently experienced several episodes of ketoacidosis.
At the age of 22, she suffered from acute episode of neurological disturbances such as hemiparesis and dysarthria. Because of her youth and the identification of oligoclonal immunoglubulins in cerebral spinal fluid and multiple abnormal high signal intensity areas on MRI, she was diagnosed as a probable case of MS. One year later, her neurological disturbance had subsided. However, certain complications of MS, such as excessive food intake and ceasing to visit the hospital because of a euphoric character, have intervened with clinical treatment and diagnosis.
Because this is the first Japanese case report of IDDM and probable MS in the same patient, it prompts us to think about the pathogenic relationship between these two disorders.
Among the various hypotheses put forth, autoimmune pathogenesis may be the most plausible. As HLA-DR2 has a positive association with MS, as does HLA-DR4 with IDDM, it is interesting that this case had both HLA-DR2 and HLA-DR4.
