Résumé :
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INTRODUCTION Inflammatory Bowel Disease (IBD) presents many neurological complications. Up to 3% of patients with IBD have neurological involvement (Thromboembolic phenomena, myelopathy, myopathy, multiple sclerosis and various neuropathies). Just one case of motor neuron disease (MND) has been previously reported. We present a case of MND in a young patient with IBD. CASE REPORT A 33 years old male diagnosed of Ulcerative Colitis at 20 years age and in treatment with mesalazine and folic acid was referred to consultation. He referred weakness in right arm a year ago and then progress to the left arm and both legs. He has no familial history of MND. In physical examination he has muscular wasting in deltoids and first dorsal interosseous, fasciculation were seen in biceps, deltoids, and quadriceps muscles and it was observed weakness in arms and legs, hiperreflexia with ankle clonus, and extensor plantar response. Blood tests were normal except for elevation of eritrosedimentation. B12 vitamin and folic acid were normal; VDRL and HIV serology were negative. CSF showed normal cell account with protein concentration of 0.75 mg/dL without oligoclonal bands. Central nervous MRI was normal. EMG revealed fasciculation and fibrillation in muscles of legs and arms, with normal conduction velocity and without block of conduction. EVOLUTION The patient received treatment with intravenous immunoglobulin 0,4 g/kg/day during 5 days, for four times without any response. The patient continues to deteriorate with severe difficulties to walk but without bulbar symptoms. DISCUSSION The physiopathology of MND is not well understood. Several factors (inflammatory, oxidative stress, apoptosis, excitotoxicity...) have been implicated. The precocious age of beginning of the disease and the co-existence of both diseases suggest that they share a common pathological basis. We discuss the possible relation between the two diseases.
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