Very Rare Incident of Pediatric Onset Multiple Sclerosis: A Case Report

Abstract

Background: Pediatric Onset Multiple Sclerosis (POMS) is a chronic inflammatory disease in the central nervous system that affects children under 18. Children with POMS experience gradual deterioration leading to increased disability and lower life expectancy [1,2]. The Purpose of the Study: to present a rare case of POMS with an onset at 42 months, emphasizing its significance due to its infrequency in this age group. The hope is to encourage the establishment of specific diagnostic and treatment guidelines for POMS in the near future. Material and Methods: The evolution of POMS in a 3.6-year-old child who was admitted multiple times to the Hospital of Mother and Child Health Care in the Republic of Moldova during acute MS attacks. Results: In September 2022, the child received a confirmed POMS diagnosis based on McDonald’s criteria (2017), which was later confirmed in April 2023 through OCB-CSF examination. The April 2023 MRI showed changes in demyelination foci with temporary clinical improvement compared to the previous examination after the last acute attack. The child is currently undergoing five days of plasmapheresis, followed by a tapering regimen of oral steroids. Ongoing MRI monitoring is recommended, with consideration of receiving Disease-Modifying Treatments (DMTs) in Romania, where they are approved. Conclusions: This rare case highlights the importance of raising awareness about POMS in children. Early detection and intervention could lead to the development of new diagnostic and treatment guidelines. However, the lack of access to DMT drugs for POMS treatment in the Republic of Moldova results in significantly lower survival rates compared to other countries.