The coexistence of sickle cell anemia and multiple sclerosis in a single patient presents a rare and challenging clinical scenario, possibly favoured by the interplay between chronic inflammatory states and autoimmune processes.

We present the case of a 36-year-old woman with sickle cell anemia who developed progressive neurological symptoms leading to frequent falls and paraparesis; magnetic resonance imaging showed many periventricular, infratentorial, and both cervical and dorsal spinal cord lesions, leading to a diagnosis of multiple sclerosis. After a multidisciplinary approach the patient was successfully started on ofatumumab.

This case report raises awareness among clinicians to consider the possibility of multiple sclerosis in patients with sickle cell anemia who present with neurological symptoms, ensuring timely diagnosis and intervention, and emphasizes the need for a personalized, multidisciplinary approach to care.