Aa
Aa
A
A
A
Close
Avatar universal

MS or Lupus?

Hello.  I have been plagued by overwhelming fatigue, tremors, vision changes, vertigo/loss of proprioception, difficulty finding words, confusion, and limb heaviness/weakness, all of which come and go in a "relapsing" manner.  I have been thoroughly evaluated for MS (MRI, VEP's, LP...all negative) and excessive labs.  The only things that have come back abnormal are positive IgG EBV in spinal fluid and the connective tissue profile (blood) showed positive dsDNA but negative ANA.  Could this all be Lupus without the typical sx's (rash, etc.) or more likely MS just not "showing up" yet?  
5 Responses
Sort by: Helpful Oldest Newest
Avatar universal
MEDICAL PROFESSIONAL
Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

Without the ability to examine you and obtain a history, I can not tell you what the exact cause of your symptoms is. However I will try to provide you with some useful information.

In the absence of any evidence of disease on brain imaging and other tests that you have had, it is less likely to be MS. Especially if you have had symptoms in a relapsing manner, over a period of time, something or the other should show up, especially on the brain MRI. It is much less likely that it is MS that has not shown up yet, although it always remains a possibility. Lesions can develop in the brain over time. But again if you have had recurring neurological symptoms, it usually correlates with a lesion in the brain, if it is MS.

A neurologist would not be the best person to comment on the diagnosis of Lupus in the presence of these antibodies. As far as I know, dsDNA is pretty specific for Lupus and you can have that diagnosis without all the classic symptoms. You should be evaluated by a Rheumatologist who deal with such a situation all the time and would be able to tell you if this is possible Lupus or not. Usually if Lupus affects the brain it is severe, and again would show up on all the neurological testing you have had. More vague symptoms like fatigue, weakness, confusion can be seen with Lupus.

I hope this helps.

Good Luck!
Helpful - 0
Avatar universal
MEDICAL PROFESSIONAL
Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

Without the ability to obtain a history from you and examine you, I can not comment on a formal diagnosis or treatment plan for your symptoms. However, I will try to provide you with some information regarding this matter.

The constellation of symptoms you describe are not specific to any diagnosis. You symptoms localize to both peripheral and central nervous systems. With normal MRI, VEPs, and lumbar punctures (assuming a complete demyelinating workup was performed including, but not limited to, IgG index, oligoclonal bands, and myelin basic protein), it seems that multiple sclerosis is less likely.

Regarding the IgG EBV: many neurological manifestations can occur, but usually in the acute phase of infection. (IgG antibodies are usually an indicator of chronic infection or prior infection). The neurological manifestations include inflammation of your brain and its coverings (i.e., meningitis, encephalitis, cerebellitis), or spinal cord (i.e., transverse myelitis), or eye (i.e., optic neuritis), cranial neuropathy, or small fiber neuropathy. It does not seem your symptoms fit into these. For example, proprioception/vibration is a large fiber phenomenon, and I am unsure of what you mean by vision changes.

The positive double stranded DNA (dsDNA) is quite specific for lupus at a frequency quoted anywhere from 40-90%.  Lupus can have central and peripheral manifestations. Some of the central manifestations include episodic affective or psychotic disorders. Disorders of consciousness can sometimes occur. Focal neurological deficits may result from strokes from cardiac valves, or vasculitis (i.e., blood vessel narrowing/inflammation) or from a hypercoagulable state (i.e., prone to clot). In some people, disorders of movement may occur. The peripheral manifestations include peripheral neuropathy (sensory or motor).

As you can see above, the neurological manifestations of lupus are many. The same is true of the systemic findings that you indicated (such as rash which may only occur in 78% of patients with lupus at some point during their lifetime). The diagnosis of lupus is complex and would be best worked up by a rheumatologist.

Thank you for using the forum, I hope you find this information useful, good luck.
Helpful - 0
Avatar universal
Thank you, you were both very helpful.  I am not sure if you follow up with any further questions but just in case:

Dr. Newey,
I assume that the pathologist who interpreted my spinal fluid took it as a "recent infection" (this is how it was noted on the report) since there was no EBNA present.  The vision changes I experienced started out as a seemingly bilateral blurred vision, especially in lower light.  This progressed to and extreme decrease in vision (it just seemed like light wasn't getting through) in my right eye.  During this time, at it's worst in fact, I had strabismus (??my eyes were not looking in same direction).  These vision changes occurred over a period of 2-3 weeks and then completely cleared up.

Sara,
The only "neurologic" sx present at the time of the MRI was the vision loss.  Other than that my only sx were extreme fatigue and weakness.  Oh, and tremor.  The vibration/tingling/numbness occurred after the MRI which was done in January.  

Both,
I am waiting (and have been for almost 2 months now) to see a Rheumatologist.  I will see him June 25.  In the interim he looked over my records (including labs) and does not believe this is lupus.  

Another symptom I forgot to mention (remembering now since it is occurring now) is twitching.  Last month my chin was twitching, so much that you could visibly see it, for an entire day.  Right now my left eyelid has been twitching for nearly 48 hours (off and on).  It's annoying.

Thank you again.  Your time is much appreciated!


Helpful - 0
Avatar universal
I was also wondering if anyone could comment on EBV being in the spinal fluid.  Is this typical?  Or does that mean that it has "infected" the nervous system?  The spinal fluid was positive for EBV IgG, but negative for IgM and EBNA.

Thanks
Helpful - 0
Avatar universal
Could be stress (and/or) anxiety?
Helpful - 0

You are reading content posted in the Neurology Forum

Popular Resources
Find out how beta-blocker eye drops show promising results for acute migraine relief.
In this special Missouri Medicine report, doctors examine advances in diagnosis and treatment of this devastating and costly neurodegenerative disease.
Here are 12 simple – and fun! – ways to boost your brainpower.
Discover some of the causes of dizziness and how to treat it.
Discover the common causes of headaches and how to treat headache pain.
Two of the largest studies on Alzheimer’s have yielded new clues about the disease