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Background: Although ankylosing spondylitis (AS) is primarily a disease of the spine and the large joints, it may also have extraarticular involvement. There are limited cases of AS patients developing multiple sclerosis (MS). Objective: In this report, we present an AS patient who developed MS during the follow up period. Patient and methods: A 36-year-old male complained of back stiffness and back pain for about 4-5 years. He had physiotherapy for about a year. His complaints did not decline. In January of 2014, sacroiliitis was detected on the patient's sacroiliac MRI. HLA-B27 was positive. The patient was diagnosed with ankylosing spondylitis. In February of 2014, he was unable to walk. After 3 doses of 20 mg IM methylprednisolone treatment, his complaints partially resolved. A thoracic MRI was taken to determine the etiology of the walking impairment. Demyelinating lesions were detected in multiple levels. The patient was referred to our clinic. Neurological examination revealed bilateral Achilles clonus, spastic gait, and brisk deep tendon reflexes on the left lower extremity. Results: A brain and cervical MRI were taken on suspicion of demyelinating disease. Multiple demyelinating lesions were detected in the brain and at multiple levels on the cervical MRI. Conclusion: Although MS can be associated with many autoimmune diseases, coexistence with AS is very rare. Although the individual pathogenesis of both diseases is unknown, when they develop together, the most likely mechanism is T-cell-mediated autoimmunity. Due to the absence of demyelinating lesions in the previous cervical MRI, another cervical MRI was not taken after clinical deterioration. Demyelinating lesions were incidentally detected in the thoracic MRI. Clinicians should consider the possibility of MS in patients with AS, especially those who are worsening.

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