We report the case of a 10-year-old male with no history of interest, bilateral gonalgia, back pain and low back pain after a bicycle fall 4 days ago.
Physical examination revealed active and passive mobility, with pain in both lower limbs.
No data on fractures or neurological disorders were observed.
Sport rest and local cold treatment were prescribed.
At 48 hours, the patient comes again due to persistent pain, loss of strength, paresthesia in the lower limbs, difficulty in walking and walking, and urinary incontinence.
Physical examination revealed decreased strength and altered sensitivity in both lower limbs.
Suspicion of transverse myelitis was referred to the hospital emergency department.
During her admission the blood analysis was normal, the study of the cerebrospinal fluid revealed moderate pleocytosis, without the presence of oligoclonal bands of IgG; the electroencephalogram showed no abnormalities and the evoked MM decreases.
The electromyography revealed an alteration of the medullary somatosensory sensation through the posterior cords, without conduction through the right cord and with partial alteration of the left cord.
Magnetic resonance imaging (MRI) of the brain was normal, however, MRI of the spinal cord showed an expansive lesion at the medullary level from D1 to D6 compatible with transverse myelitis.
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At 24 hours of admission, the patient developed severe pain in the right eye with sudden loss of visual acuity.
She was diagnosed with right optic neuritis.
The presence of transverse myelitis optica, with cerebral MRI did not meet criteria for multiple sclerosis and 4 medullary MRI showing three or more medullary segments (D1 to D6) was negative, antiacid
According to the clinical evolution and despite the negativity of the antibody, the patient was diagnosed with optic neuromyelitis or Devic's disease (see diagnostic criteria Table 1).
1.
Initially the patient was treated with intravenous methylprednisolone at a dose of 1 g/day without improvement, so plasmapheresis was performed with good clinical outcome.
The patient was followed by neurology, radiology and urology with progressive improvement of corticotherapy.
Fourteen months later, the patient presented complete lower limb strength and sensitivity, normal gait, normal reflexes, absence of authenticity, ataxia or dysmetria; occasionally he presented self-limiting painful lumbar hyperesthesia.
In the right eye, the patient maintains a blurred vision, with attenuation of color perception, although he has regained 70% of visual acuity.
Nocturnal bladder authenticity persists and continues to be treated with desmopressin.
