Case report| Volume 30, P244-246, May 2019

Download started.


Hypocomplementemic urticarial vasculitis and multiple Sclerosis: A rare association or an atypical presentation?

Published:February 15, 2019DOI:


      • Implications of Multiple Sclerosis associated with other immune-mediated diseases are rarely discussed.
      • Rituximab stabilized disease activity in a patient with Multiple Sclerosis and Hypocomplementemic Urticarial Vasculitis.
      • More reports are needed to help clarify the best approach in Multiple Sclerosis with concurrent autoimmune diseases.



      Multiple Sclerosis (MS) has been associated with several immune-mediated diseases but the mechanisms that explain such associations, as well as their implications in clinical practice and treatment are rarely discussed.

      Case presentation

      We report the case of a patient with a history of MS since she was 27 years old, followed by a diagnosis of Hypocomplementemic Urticarial Vasculitis (HUV) seven years later. Several disease-modifying treatments for MS and HUV were used but with limited benefit in both diseases and significant MS progression. Activity of both diseases was later stabilized with Rituximab. We discuss the hypotheses of a central nervous system involvement in urticarial vasculitis or an association between MS and HUV, and examine the challenges in their management.


      In the presence of concurrent immune-mediated diseases, the diagnosis of MS can be challenging. This clinical presentation posed significant difficulties in disease management, influencing therapeutic options and their effectiveness/adverse effects profile. The best approach in MS patients with concurrent autoimmune diseases remains to be established and more reports are needed to help clarify this subject.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Multiple Sclerosis and Related Disorders
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Al-Jaderi Z.
        • Maghazachi A.A.
        Utilization of dimethyl fumarate and related molecules for treatment of multiple sclerosis, cancer, and other diseases.
        Front. Immunol. 2016; 7: 278
        • Balak D.M.
        • Hengstman G.J.
        • Çakmak A.
        • et al.
        Cutaneous adverse events associated with disease-modifying treatment in multiple sclerosis: a systematic review.
        Mult. Scler. 2012; 18: 1705-1717
        • Buck A.
        • Christensen J.
        • McCarty M.
        Hypocomplementemic urticarial vasculitis syndrome: a case report and literature review.
        J. Clin. Aesthet. Dermatol. 2012; 5: 36-46
        • Chouhfeh L.
        • Kavak K.S.
        • Teter B.E.
        • et al.
        Disease modifying therapies use associated with comorbid autoimmune diseases in multiple sclerosis patients.
        Mult. Scler. Relat. Disord. 2015; 4: 228-233
        • Jachiet M.
        • Flageul B.
        • Deroux A.
        • et al.
        The clinical spectrum and therapeutic management of hypocomplementemic urticarial vasculitis: data from a French nationwide study of fifty-seven patients.
        Arthritis Rheumatol. 2015; 67: 527-534
        • Marrie R.A.
        • Reider N.
        • Cohen J.
        • et al.
        A systematic review of the incidence and prevalence of autoimmune disease in multiple sclerosis.
        Mult. Scler. 2015; 21: 282-293
        • Mitsikostas D.D.
        • Goodin D.S.
        Comparing the efficacy of disease-modifying therapies in multiple sclerosis.
        Mult. Scler. Relat. Disord. 2017; 18: 109-116