LETTERS TO THE EDITOR
|Year : 2019 | Volume
| Issue : 2 | Page : 252-253
Mimickers of amyotrophic lateral sclerosis
Ayush Dubey1, Shubham Dubey2
1 Consultant Neurologist, Bhopal, India
2 Department of Neurology, Meenakshi Medical College Hospital and Research Institute, Kanchipuram, Tamil Nadu, India
|Date of Web Publication||9-Apr-2019|
Dr. Ayush Dubey
E-29, 45 Bungalows, T T Nagar, Bhopal, Madhya Pradesh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Dubey A, Dubey S. Mimickers of amyotrophic lateral sclerosis. Ann Indian Acad Neurol 2019;22:252-3
We read with interest the article titled, “Clinical mimickers of amyotrophic lateral sclerosis-conditions we cannot afford to miss” by Singh et al. We appreciate the authors' effort and research work for coming up with a comprehensive list of amyotrophic lateral sclerosis (ALS) mimickers. We would like to highlight upon two more conditions described in the text which resemble ALS:
- Eosinophilic fasciitis is a rare localized scleroderma-like disorder with symmetric skin changes including an initial edema and erythema of the extremities, followed by woody skin induration in a later phase. This induration leads to joint contractures with limited mobility. Laboratory tests may show peripheral eosinophilia, hypergammaglobulinemia, and an elevated erythrocyte sedimentation rate. Godeiro-Junior et al. have described it in the fourth decade of life with presentation with early-onset generalized fasciculations and electromyography findings of active denervation and reinnervation, which suggests a neurogenic process and raises a doubt in diagnosis. However, associated clinical features such as swollen knees in the described case as well as skin features hint toward the diagnosis. These cases generally show an excellent response to steroids with complete resolution of the complaints
- Lyme disease is very challenging in diagnosis since it mimics other neurological disorders such as ALS or Guillain–Barre syndrome. Careful and detailed examination and investigation are required to confirm the diagnosis and to prevent misleading inaccurate diagnoses. Burakgazi  have described a patient with a 1-month history of rapidly progressive weakness involving bulbar, upper limb, and lower limb muscles. The physical examination showed widespread weakness, atrophy, fasciculation, and brisk reflexes. The initial electrodiagnostic test showed widespread active and chronic denervation findings. The initial physical and electrodiagnostic findings were suggestive of ALS. However, blood serology indicated possible Lyme disease. Thus, the patient was treated with doxycycline. The clinical and electrodiagnostic findings were resolved with the treatment.
Thus, there are many disorders which match the clinical presentation of ALS. A meticulous approach should be used both clinically and in investigations to rule out various conditions before arriving at the final diagnosis of this dreaded disease.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Singh N, Ray S, Srivastava A. Clinical mimickers of amyotrophic lateral sclerosis-conditions we cannot afford to miss. Ann Indian Acad Neurol 2018;21:173-8.
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Godeiro-Junior C, Felicio AC, Goldzveig J, Chieia MA, Schmidt B, Oliveira AS, et al.
An amyotrophic lateral sclerosis mimicker: Eosinophilic fasciitis. Arq Neuropsiquiatr 2008;66:888-90.
Burakgazi AZ. Lyme disease – Induced polyradiculopathy mimicking amyotrophic lateral sclerosis. Int J Neurosci 2014;124:859-62.