Pediatric Wilson Disease in Sudan: A Rare Case, Sudan Conflict and Diagnostic Challenges.

Wilson disease is rarely reported among African children. Wilson disease is due to a mutation in ATP7B on an autosomal recessive pattern, which causes defective copper excretion and copper accumulation in tissues such as liver and brain. To the best of our knowledge, this is the second reported case of Wilson disease from Sudan, and it highlights the challenges of diagnosis and management in low-resource settings. Our report strengthens the need for awareness and accountability of rare diseases in public health systems, especially when access to diagnostics and special therapies is limited. A 13-year-old male of Sudanese descent with consanguineous parents presented with progressive generalized edema, jaundice, and ascites. On physical examination, Kayser-Fleischer rings were observed. Laboratory tests revealed hypoalbuminemia, thrombocytopenia, and a family history of sibling deaths. Additionally, there was a difference in neuropsychiatric status. MRI of the brain demonstrated hyperintensities in the basal ganglia, known as the "giant panda sign." A diagnosis of Wilson disease was made, with a Leipzig score of 7/10, based on low serum copper, hemolytic anemia, and the family history. Initial therapy with D-penicillamine and then zinc was administered, but it failed to prevent neurological decline. This deterioration occurred between visits. Moreover, the only alternate therapy, trientine, in all its forms, was not available at the time. Wilson disease, thought rare, occurs in African children but remains underdiagnosed due to resource constraints. This case highlights diagnostic challenges, the critical role of clinical suspicion, and urgent need for accessible diagnostic and affordable therapies in low-resource settings to improve outcome.