Pragmatics is the ability to integrate language in context and to communicateeffectively. This skill is essential in many aspects of communication in daily life, both incomprehension and in production, to understand the speaker’s intended meaning andto convey a message adequately. Recent studies showed that pragmatics may beimpaired in Multiple Sclerosis (MS), with a possible impact on quality of life. Here wepresent the case of a patient with secondary progressive MS who, upon admission tothe hospital for physical rehabilitation, showed almost no impairment inneuropsychological assessment, except for a subtle pragmatic impairment as revealedthrough the Assessment of Pragmatic Abilities and Cognitive Substrates (APACS test).During hospitalization, the patient suffered a sudden worsening of MS-relatedsymptoms. In the neuropsychological assessment after the clinical worsening, the patient showed a remarkably stable cognitive profile (except for tests influenced bypsychomotor speed), but a marked worsening in pragmatic test scores, especiallythose requiring extensive verbal production. Starting from the dissociation betweencognitive and pragmatic aspects, we conclude that pragmatics may be particularlysusceptible to clinical worsening in MS and discuss the importance of consideringcommunicative skills in MS.