Multiple sclerosis in a patient with chronic ulcerative colitis.

282 CMYK Danazol, prednisolone, insulin and physiotherapy were prescribed. At discharge his platelet count was 1,20,000/cumm and perception of sensations and muscle power in both upper limbs was improving. At follow-up after one and a half months, the power also improved, but he required prednisolone and danazol for maintaining a good platelet count. “Kaleidoscopic autoimmunity” has been reported with various diseases. Our patient developed transient DIC, diabetes mellitus and multiple plexopathy following splenectomy. Multiple plexopathy has a variable presentation. One of the forms is neuralgic amyotrophy (NA) or acute brachial neuritis (ABN) which usually presents as severe pain in the shoulder followed by weakness of shoulder girdle muscles. Moore et al reported a case of lumbosacral plexopathy in a woman with CREST syndrome and vasculitis. The most common mechanism is thought to be viral etiology or immune-mediated. Blood lymphocytes are known to get sensitized to branchial plexus nerves in patients with neuralgic amyotrophy. It is usually unilateral with rare bilateral asymmetrical findings. Sensory symptoms are rare. Sometimes patchy sensory loss may be present. Electrophysiological studies might demonstrate sub-clinical involvement in asymptomatic limbs in up to 25% of patients and very rarely there is a mild lymphocytic pleocytosis or a rise in protein in the CSF. In our patient there was bilateral asymmetrical involvement which is a rare presentation along with weakness without any pain. Our patient also had right common peroneal nerve involvement demonstrated by electrophysiological studies. Prognosis of NA is good with full recovery of strength in 90% of the patients by three years. Plexopathy in our patient was probably immune-mediated. The cause for DIC in our patient was most probably immune-mediated though surgical trauma or diabetic ketoacidosis with severe dehydration contributing to DIC could not be ruled out.