Brinar VV, Habek M.
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 [WE DO NOT KNOW THE FREQUENCY, BUT HAVE SEEN BARTONELLA PATIENTS HAVE SEVERE DAMAGE TO TISSUE AND NEURONAL CELLS AND ARE NOT SURE THIS SHOULD BE IGNORED. ESPECIALLY BECAUSE A FULL LITERATURE REVIEW SHOWS IMMUNITY IS LOWERED BY BARTONELLA]. 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.
Clin Neurol Neurosurg. 2010 May 1; Rare infections mimicking MS.