Editorial| Volume 45, 102427, October 2020

Multiple sclerosis in a young woman with sickle cell disease


      • The comorbidity of sickle cell disease requires significant considerations in the management of MS.
      • If corticosteroids are used to treat an MS exacerbation in a patient with SCD, pre-treating with automated red blood cell exchange should strongly be considered.
      • Plasma exchange may also be considered in the treatment of an MS exacerbation in a patient with SCD.
      • Natalizumab and dimethyl fumarate are disease-modifying therapies currently being investigated pre-clinically as potential therapeutic options for SCD.



      Comorbidities can impose diagnostic and treatment challenges in patients with multiple sclerosis (MS). Sickle cell disease (SCD) and MS are both inflammatory diseases featuring immune system dysregulation, and the reciprocal interaction of these diseases deserves investigation.


      We present the case of a 28-year-old woman with SCD who developed a sickle cell crisis and acute chest syndrome during corticosteroid treatment for a first MS attack. We then provide a review of the literature on co-management of SCD and MS. In patients with SCD experiencing an acute MS exacerbation, pre-treatment with red blood cell exchange transfusion before corticosteroids may reduce adverse vaso-occlusive events. Plasma exchange may also be considered. Finally, we discuss innovative pre-clinical research that suggests that natalizumab or dimethyl fumarate may ameliorate SCD symptoms while preventing MS relapses; human trials, however, are needed.


      The co-occurrence of inflammatory disorders, in this case MS and SCD, requires providers to appropriately manage each condition with consideration of the other. Future studies may generate shared avenues for treatment.


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