Neurologic involvement in an overlapping systemic pathology

Maria Bujor^(1,*), Delia Tulba^(2,3), Razvan Adrian Ionescu^(1,3)

1)3rd Internal Medicine Department, Colentina Clinical Hospital, Bucharest, Romania
2)Colentina Clinical Hospital, Neurology Department, Bucharest, Romania
3)Internal Medicine Department, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania

Background. Overlap syndromes are complex conditions, comprising elements of more than one distinct autoimmune disease, as well as multiorgan involvement.
Methods. We present the case of a 48-year-old female patient with systemic lupus erythematosus (SLE)/systemic sclerosis (SSc)/Sjögren syndrome (SS) overlap and a myriad of neurological manifestations, including bilateral trigeminal neuralgia, bilateral facial nerve palsy, mononeuritis multiplex and migraines cephalalgia.
Results. Physical examination revealed bilateral involuntary spasms of the lower face, bilateral facial motor deficit, a mild motor deficit of the lower limbs (4/5), tactile hypoesthesia on the left thigh, a diminished right patellar reflex and a positive bilateral Hoffman sign. This neurological symptomatology was present during an apparent inactive state of the rheumatologic condition, with no signs of active arthritis, and the following laboratory results: a mild normocytic normochromic anemia, mild leukopenia, a mildly decreased C3 and a mildly elevated ESR. Cerebral MRI revealed T2/FLAIR-hyperintense subcortical white matter lesions, suggestive of demyelination, without meeting the multiple sclerosis (MS) pattern.
Conclusion. The main clinical question arising from this case resides in the nature of the neurological involvement, in relation to the overlap syndrome.

Keywords: overlap syndrome, neurologic involvement, MRI

Corresponding author(s): Maria Bujor, Colentina Clinical Hospital, 19-21 Stefan cel Mare road, bldg. "E”, Ground-floor, e-mail: maria.bujor2701@gmail.com