[Diagnostic and therapeutic challenges of neuromyelitis optica in Côte d'Ivoire: a pediatric case report].

Introduction: Neuromyelitis optica (NMO) is an inflammatory and demyelinating disease of the central nervous system (CNS) that typically progresses in episodes. The average age of onset is around 40 years old, though there are also pediatric forms. We present our first pediatric case and discuss its unique features. Clinical observation: An 8-year-old child was hospitalized in June 2023 due to motor deficits in all four limbs. In November 2021, she presented with a binocular decrease in visual acuity, followed by partial recovery. Eleven months later, she experienced a second, more severe episode without recovery. In May 2023, she presented with uncontrollable vomiting and a mild motor deficit in all four limbs. By June 2023, she reported significant asthenia, severe facial itching, and worsening motor deficits. Her EDSS score was estimated at 8. Ophthalmologically, she had an absence of light perception and optic atrophy on fundus examination. Testing confirmed seropositive NMO. Following corticosteroid therapy, she showed clinical improvement with an EDSS score of 5.5. Following a relapse on azathioprine, her condition remained stable on rituximab. Discussion: NMO accounts for 3 to 5% of all NMO cases in children and is often underdiagnosed. There is clinical and radiological heterogeneity in pediatric NMO. Misleading forms, such as area prostema syndrome (which is quite common in children), should not be overlooked. Basic treatments are based on immunosuppressants. Conclusion: NMO is a rare and little-known condition in sub-Saharan Africa, with flare-ups representing genuine therapeutic emergencies.