Neuromyelitis Optica Spectrum Disorder (NMOSD) in Childhood: Case Report and Diagnostic Challenges in Nicaragua
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Keywords
Neuromyelitis Optica, Aquaporin 4, Autoantibodies, Child, Magnetic Resonance Imaging, Rituximab
Abstract
NMOSD has higher relapse rates and disability progression than multiple sclerosis; in pediatrics, early recognition and timely immunotherapy are critical. Case: Managed at the Hospital Militar Escuela “Dr. Alejandro Dávila Bolaños”, Nicaragua, a 4-year-old girl with level II autism spectrum disorder and developmental delay presented with one month of ataxia, gait disturbance, behavioral changes, hypoactivity, and visual complaints. The initial MRI was non-diagnostic; subsequent imaging revealed lesions compatible with NMOSD. Serum anti–aquaporin-4 antibodies (AQP4-IgG) confirmed the diagnosis, enabling initiation of high-dose methylprednisolone followed by maintenance rituximab, with neurological improvement. The early age and ASD complicated clinical assessment; female sex aligns with the known higher prevalence in girls. Conclusions: This case highlights the need for high clinical suspicion in pediatric NMOSD, repeat neuroimaging when the first MRI is inconclusive, and prompt access to AQP4-IgG testing. Limited access to diagnostics and therapies in Nicaragua remains a key challenge to reducing relapses and disability.
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MD Carlos Cristiam Bolaños Caldera , Hospital Militar Escuela Dr. Alejandro Dávila Bolaños, Nicaragua.
Médico Especialista en Pediatría Neurología
MD Adriana Arriaza , Hospital Militar Escuela Dr. Alejandro Dávila Bolaños, Nicaragua.
Médico Residente de Pediatría de 3er año
MD María Guadalupe Calderón, Hospital Militar Escuela Dr. Alejandro Dávila Bolaños, Nicaragua.
Médico Residente de Pediatría de 3er año
MD Liezel Hansack, Hospital Militar Escuela Dr. Alejandro Dávila Bolaños, Nicaragua.
Médico Residente de Pediatría de 3er año
MD Lorena Ortega, Hospital Militar Escuela Dr. Alejandro Dávila Bolaños, Nicaragua.
Médico Residente de Pediatría de 3er año