Rectal pallesthesia as a novel symptom of multiple sclerosis: A case report

Sensory symptoms are common in multiple sclerosis, but atypical manifestations remain under-recognized, contributing to diagnostic delay. We report a 34-year-old woman with bilateral limb paresthesias and a positive Lhermitte’s sign who subsequently developed a new-onset episodic rectal vibratory sensation (pallesthesia). Magnetic resonance imaging demonstrated demyelinating lesions at C2/3, T9, an equivocal conus medullaris lesion, and disseminated brain involvement. Alternative inflammatory diagnoses were excluded. To our knowledge, this is the first documented case of rectal pallesthesia as a manifestation of multiple sclerosis, underscoring the need to consider central demyelinating pathologies in unexplained pelvic sensory disturbances.