Neuromyelitis optica in childhood: a case report

*Correspondence: [e-mail].

Abstract

Case Presentation: F.A., 12 years old, female, started with asymmetrical ascending flaccid paraparesis, global arreflexia, ataxia, dysphagia and dysarthria 20 days after Pfizer vaccination for SARS-COV-2. On admission, after 2 months, was suggested acute polyradiculoneuritis hypothesis and immunoglobulin was administered without improvement of the symptoms. However, the patient evolved with signs of pyramidal release and methylprednisolone was administered with a good outcome. CSF: cytology: 0/mm³, glucose: 59/mm³, protein: 34/mm³. Electroneuromyography (ENMG): upper and lower limbs show signs of polyradiculoneuritis in the hyperacute phase, the nature cannot be classified as myelin or axonal; Cranial resonance Magnetic Imaging (MRI): signal alteration compromising supra and infratentorial structures, T2/FLAIR symmetrical hypersignal in the bulbopontine transition suspicious for a demyelinating process. Cervical/ thoracic spine MRI: no abnormalities. Anti Aquaporin-4 IgG: reagent.

Discussion: Neuromyelitis optica (NMO) is a relatively rare inflammatory disease that primarily affects the spinal cord and optic nerves. Clinical features are frequently more diverse than just optic neuritis and transverse myelitis in children what makes the diagnosis challenging. The case series of pediatric NMO have shown a female preponderance and almost all NMO-IgG positive, which had relapsing course predicted by seropositivity. The median age of children diagnosed with NMO ranges from 10 to 14 years. Coexisting autoimmune disorders were reported in 42%. Longer term immunotherapy reduces the chance of further potentially disabling attacks.

Final Comments: Diagnosis of NMO is not easy, especially when patients are children. This case report intends to bring to discussion this condition once the disease is potentially severe - risk of irreversible focal neurological deficits - and need to be early diagnosed to promote better therapeutic strategies and prognosis.

Publication History

Article published online:
12 May 2025