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Devic's neuromyelitis optica (NMO) or a pediatric onset multiple sclerosis (MS)? A case report

Introduction:Neuromyelitis Optica(OMN) is an inflammatory demyelinating disease of the central nervous system characterized mainly by uni-or bilateral optic neuritis and acute myelitis.Objectives:We report a case of pediatric onset and show the diagnostic challenge.Methods:7-year-old girl,without past medical history,presented a progressive onset of back pain,right eye deviation and gait disorder,in an apyretic context and without disturbances of consciousness,absence of trauma.Clinical exam objectives paraplegia,cerebellar syndrome,pyramidal syndrome,normal consciousness,no sepsis,growth is nomal.Cerebrospinal(CS)MRI reveals diffuse CS demyelinating lesions with presence of active plaques(fig1).Ophthalmological examination shows a bilateral optical neuropathy.Visual Evoked Potentials(EVP) are discernible but altered on both sides.CSF study with isoelectric focusing of Ig of CSF shows the presence of intrathecal synthesis of immunoglobulins(Ig).Blood tests revealed a mild hypoprotidemia and mild hypoalbuminemia 33g/l.The patient received 500mg/d of methylprenisolone bolus over 3 days.Evolvement is a complete recovery after37 days.At 5th month the child has cramps of hands and legs,early tiredness at the writing,tingling of the 4 limbs,left stepage,bone -tendon reflex are slightly accentuated at the lower left limb.AntiMOG antibodies test was positive,the antiaquaporin4 antibodies test was negative.The 2nd CS-MRI shows persistence of the same demyelinating lesions.Results:The radioclinical findings evoke an acute demyelinating disease,the presence of intrathecal Ig makes suspecting a first outbreak of MS,against,the clinical evolution,the absence of appearance of new lesions to imaging and the subsequent positivity of antiMOG antibodies makes the diagnosis of NMO possible.Conclusion:Our case study confirms the difficulty in diagnosis of pediatric NMO orMS in practice wich need a long-term follow-up.D.Biotti et al.Spectre de la neuromyélite optique et anticorps anti-MOG,revue neurologique171s(2015)
Keywords: Devic's syndrome, neuromyelitis optica,Mutiple sclerosis,AntiMOG antibody,pediatric