A cluster of 42 patients was identified, out of 600 employed at a California courthouse. The worksite was known to have had 20 years of water intrusion, chronic dampness and mold growth, including the toxigenic Stachybotrys chartarum. Environmental testing confirmed the presence of air borne mold amplification in every room tested, distributed by a contaminated HVAC system. Surface and bulk mycotoxin levels were uniformly elevated from micro- to milligram ranges for trichothecenes, satratoxins, and aflatoxins. Corresponding ELISA serology was present in the employees with elevations in a series of mold hypersensitivity pneumonitis panels and ELISA mycotoxin panels for trichothecenes, satratoxins, and aflatoxins in over 95% of the patients. Immune function testing was abnormal in over 95% of the patients, with decreases in Interleukin-2 and Natural Killer Cell (T-lymphocyte) number and function. Forty-two of the employees complained of neurological deficit including memory loss, cognitive dysfunction, dizziness, abnormalities of executive functioning, headaches, visual disturbances, and symptoms of numbness and weakness of the extremities. These patients had signs of memory loss, cognitive dysfunction, executive dysfunction, sensory and motor deficits, postive Romberg Signs and ataxia. These patients had positive MRI and PET scan findings consistent with areas of demyelination. Neurological antibody testing was positive, including for myelin associated glycoprotein, glutamate receptors, myelin basic protein, chondroitin sulfate, and crystalline. These 42 patients were diagnosed with mycotoxic leukoencephalopathy, causing their Multiple Sclerosis (MS)-like syndrome. Treatment including removal of the patient from the building resulting in general improvement, with not further exacerbations of the illness. The areas of demyelination also improved or resolved with treatment. The incidence of MS is stated to be 1 per 100,000 in the general population. A cluster of 42 patients out of 600 from a single building known as a site of chronic biotoxin associated illness due to chronic dampness, mold growth and mycotoxin contamination, far exceeds a billion to one probability that it is not due to chance (p ≤ 0.05). Ruling out all other areas of differential diagnosis, the cause of this cluster is mycotoxin exposure from the indoor dampness. Mycotoxic leukoencephalopathy has been identified as the cause of this cluster of Multiple Sclerosis-like illness. Other cases of Multiple Sclerosis should be investigated for a similar cause.
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