Axonal degeneration of the peripheral nerves and postganglionic anhidrosis in a patient with multiple sclerosis

A 36-year-old woman had, since the age of 24, numerous episodes of visual loss and spinal symptoms and signs at various levels, and was diagnosed as multiple sclerosis(MS). CSF myelin-basic-protein was increased. Neurological and electrophysiological investigations suggested the peripheral nerve involvement. Sural nerve biopsy performed about six years after the onset, revealed severe loss of both myelinated and unmyelinated fibers. Subsequently, histamine skin reaction was defective in the lower limbs. Tests on sudomotor and pupillary functions indicated deficits of both central and postganglionic sympathetic systems. Though we could not detect causative factors for the peripheral nerve lesions, our patient appears to be the first documented case of MS associated with axonal degeneration of the peripheral somatic and autonomic nervous systems.