%0 Journal Article
%T Infectious and Noninfectious Granulomatosis in Patient with Multiple Sclerosis: Diagnostic Dilemmas and Followup
%A Jelena Paovic
%A Predrag Paovic
%A Vojislav Sredovic
%J Case Reports in Immunology
%D 2014
%I Hindawi Publishing Corporation
%R 10.1155/2014/876525
%X Patient was followed up over the course of 30 years. In 1978, after severe systemic infection followed by fever, pulmonary edema, and numerous neurological manifestations, patient was differentially diagnosed with apoplectic form of multiple sclerosis (MS), which was confirmed a year later via neurological and MRI findings. Approximately 20 years following the initial attack, sarcoidosis was diagnosed during the regular preoperative procedures required for cataract surgery. As consequence of lower immune system, infectious granulomatosis in form of pulmonary tuberculosis developed. Ophthalmological findings revealed bilateral retrobulbar neuritis (RBN) approximately six years after initial attack. This developed into total uveitis with retinal periphlebitis and anterior granulomatous uveitis¡ªall of which are clinically similar in both MS and sarcoidosis. 1. Introduction Sarcoidosis and multiple sclerosis (MS) belong to a group of systemic vasculitides. Besides trauma, MS as chronic inflammation with demyelination and scarring is the most frequent cause of neurologic disability. It occurs more commonly in young middle aged females. MS, disease disseminated in time and space, is characterized by frequent recidivism. If full recovery has not been achieved, definitive neurological deficits persist. During the course of the disease, magnetic resonance imaging (MRI) reveals presence of demyelinating plaques, while liquor analysis shows oligoclonal response [1¨C4]. Lesions that occur in MS are characterized by perivenous cuffing and tissue infiltration by mononuclear cells (predominantly T lymphocytes and macrophages). Demyelination appears as disease progresses and as macrophages and microglial cells form the myelin debris. Due to proliferation of astrocytes, scarring occurs. Damage of myelin sheet can in most cases be connected to previous viral infection. It is believed that stress is also one of the important triggering factors [5¨C8]. Initial symptoms of the disease are muscle weakness in one or more limbs, blurred vision (secondary to optic neuritis), sensory disturbances, ataxia, diplopia, and so forth. However, no clinical signs or findings from diagnostic procedures are unique to MS [9, 10]. Ocular manifestations such as retrobulbar neuritis (RBN), retinal vasculitis (RV), and anterior granulomatous uveitis occur as part of MS. According to some authors, RV (periphlebitis) is a primary inflammation subsequent to vitreal inflammation and snow bank formation [3, 11]. Sarcoidosis is a multisystemic, granulomatous disease of unknown etiology. As of yet, no
%U http://www.hindawi.com/journals/crii/2014/876525/