MS or Lyme Disease?

About 15 years ago I developed a very odd rash.  I do not remember having a tick bite, but the rash was very odd.  This hive-like itchy rash had a bulls-eye center and migrated all over my body.  Placed on steroids after a couple of weeks of it, and the itchy rash went away.  Just prior to the rash I noticed I was getting achy joints--knees, shoulder, fingers, etc.  I also felt like I couldn't breathe when I would lie flat in the bed.  My heart felt like it was racing.   So my GP ordered tests.  The following positives were noted:  ANA (1:90), C-Reactive-Protein, Sed-Rate (mildly elevated).

I’ve been to three different neurologists, who all did blood work.  All tests for lupus and other rheumatologic disorders were ruled out.  Lyme Disease was ruled out.  I developed migraine headaches, high blood pressure, and irregular heart beat.  The third and last rheumatologist, years later, diagnosed me with fibromyalgia.

Several years later, I went to another rheumatologist, and the diagnosis was fibromyalgia.  The joint pain finally disappeared after a while when it was discovered that I had hypothyroidism and started taking medicine for that. The joint pain went away, but MS-like symptoms started to appear including numbness, tingling, spasticity, eye problems (later diagnosed with optic neuritis), paralysis that came and went, painful feet, bladder incontinence, tremor, esophageal spasms, cognitive disorder, migraines, heat intolerance, etc. :

In 2008, I was diagnosed with MS.  MRI showed lesions in the brain around the ventricles that are demyelinating and/or ischemic according to the radiologist. I was placed on Copaxone and have been doing very well--up until now.  I've had new lesions develop in the brain and is seeking a second opinion. What are your impressions . . . Could this possibly be Lyme Disease?  I don't want to spend precious time talking about LD if it's not necessary.

[Christopher R Newey, DO]

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 a doctor.

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

In order to make the diagnosis of MS, a detailed history and neurologic examination is required. MRI is very helpful and needed as it helps determining the presence of white matter lesions in 2 or more locations, however there are multiple conditions producing MRI changes that could be mistaken for MS, and the MRI should be reviewed properly and correlated to the symptoms. If someone has several lesions on the brain MRI, but they have not had distinct episodes of neurologic symptoms, or they have specific findings on neurologic examination, then a diagnosis of MS can not be made. However, it sounds like you have some classic symptoms and signs of MS, especially based on how you describe the MRI. Have you improved on the copaxone? Lyme’s disease can be in the differential of many various neurological disorders. You did mention, though, that this was ruled out already. How was it ruled out? The rash is interesting, but may or may not be related.

I would suggest you continue following up with your neurologist.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.