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Multiple sclerosis and intrathecal IgA synthesis

A Sena1, P Rosado, V Ferret-Sena

  • 1Laboratorio de Neuroquimica, Centro de Diagnostico Computorizado, Lisboa, Portugal.

Acta Neurologica Belgica
|March 1, 1997
PubMed
Summary

This study details a multiple sclerosis case with unusual cerebrospinal fluid (CSF) findings. The patient showed significantly elevated immunoglobulin A (IgA) levels, indicating local IgA production, despite normal immunoglobulin G (IgG) markers.

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Area of Science:

  • Neurology
  • Immunology
  • Clinical Diagnostics

Background:

  • Multiple sclerosis (MS) is a chronic autoimmune disease affecting the central nervous system.
  • Cerebrospinal fluid (CSF) analysis is crucial for MS diagnosis, typically showing elevated IgG.
  • This case presents an atypical CSF profile in a patient with clinically definite MS.

Observation:

  • A 61-year-old woman presented with severe cerebellar and pyramidal tract symptoms, indicative of MS.
  • Standard diagnostic tools like evoked potentials and MRI confirmed the MS diagnosis.
  • Unusual CSF analysis revealed normal albumin, IgG, and IgG index, but markedly increased IgA levels and IgA index.

Findings:

  • The patient exhibited significant local synthesis of IgA, estimated at 31.36 mg/l.

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  • Oligoclonal IgA bands were absent, while oligoclonal IgG bands were detected.
  • The elevated IgA levels were determined to be polyclonal, suggesting a non-specific immune response.

    • Implications:

    • This case highlights the heterogeneity of CSF findings in multiple sclerosis.
    • It suggests that elevated IgA, even without oligoclonal IgA bands, may occur in MS.
    • Further research is needed to understand the role of IgA in MS pathogenesis and diagnosis.