Sociedad Española de Anatomía Patológica y División Española de la International Academy of Pathology  XXV Congreso de la Sociedad Española de Anatomía Patológica
y División Española de la International Academy of Pathology
XX Congreso de la Sociedad Española de Citología
I Congreso de la Sociedad Española de Patología Forense
   Sociedad Española de Patología Forense
Zaragoza, 18 a 21 de mayo de 2011


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Comunicación oral nº 57. Tema: Neuropatología

Post-mortem diagnosis of multiple sclerosis in a patient with severe cardiac failure and acute pulmonary edema as the presenting symptoms: A case report and review of the literature
D Díaz Díaz (1), B Pérez Hurtado (2), J Salazar Tabares (2), A Ballén Barragán (2), A Cabello Fernández (2)
(1) Hospital Universitario 12 de Octubre, (2) Hospital Universitario 12 de Octubre

Introducción:Multiple sclerosis (MS) is known to cause dysfunction of the central nervous system by dysregulation of the peripheral immune system leading to recurrent episodes of demyelination and acute inflammation, affecting optic nerves, spinal cord and critical areas of the brain. The development of MS requires the combination of a genetically susceptible individual and a particular environmental trigger. Acute pulmonary edema and severe heart failure are extremely rare events in patients affected by MS.

Material y métodos:Post-mortem studies of the central nervous system (CNS), heart and lungs were performed. For light microscopic examination, paraffin sections of the brain and spinal cord were stained with HE, PAS and Luxol Fast Blue. Immunohistochemical techniques were performed using monoclonal and polyclonal antibodies for neurofilaments, inflammatory cells and astroglia. MEDLINE database was used to review papers related to MS, cardiac failure and pulmonary edema until 2011.

Resultados:A previously healthy 25 year-old woman was admitted with findings of acute heart failure and pulmonary edema. During the five preceding weeks the patient complained of fatigue, vertigo and relapsing facial palsy. Suddenly the patient developed cardiogenic shock and acute pulmonary edema. Viral serology was positive for Epstein Barr IgG. Hematological, autoimmune, and biochemical profiles were normal, apart from a neutrophil leucocytosis and elevated C-reactive protein. Endocardial histological examination and bone marrow studies were unremarkable. Four days later the patient died after developing multiorganic failure. MS was discovered during autopsy. CNS macroscopic study disclosed multiple plaques of demyelination in the white matter of middle and posterior thalamus, right subcortical occipital lobe, left frontal lobe and tegmental brain stem. Histologically, the affected tissues exhibit myelin loss with partial axonal preservation, reactive astrocytosis of variable intensity, perivascular T lymphocytes and diffuse infiltration by foamy lipid-laden macrophages. In the medulla, there was a demyelinated gliotic plaque extensively compromising the tegmental area, including the autonomic nuclei. The heart showed a slight left ventricular hypertrophy with normal histology. Immunoreactivity for CD45, CD3, CD68 and GFAP confirmed the nature of this entity.

Conclusión:We should increase the awareness in previously healthy patients in which MS can present as cardiogenic shock and acute pulmonary edema.

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Actualizado: 11/06/2011