| Summary: | Multiple sclerosis (MS) is generally believed to be extremely rare in black African children, and the primary progressive form is the rarest type. We describe a case of primary progressive multiple sclerosis (PPMS) in a 10-year-old Nigerian boy and highlight the challenges of management in a resource-limited setting. He presented with 2 years history of inability to neither walk nor use the left upper limb, and a year history of progressive loss of vision. The symptoms were insidious in onset and associated with nasal and slurred speech, hesitancy, incomplete voiding, and occasional jerky movement of the lower limbs. Examination revealed a cheerful child with good memory and intelligence. There were reduced muscle power and lead-pipe rigidity in all the limbs except the right upper limb which was normal. Fundoscopy revealed bilateral optic atrophy. The diagnosis of PPMS was made by the typical clinical presentation, and brain and spinal cord magnetic resonance imaging (MRI). We had no facilities for cerebrospinal uid monoclonal IgG. This case highlights the need for pediatricians in the tropics to have a high index of suspicion and for healthcare systems to be equipped with facilities to accurately diagnose pediatric MS.
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