Abstract Ref Number = APCP731
A REGRESSION STATE OF A TEN YEARS OLD BOY WITH SUSPECTED AUTOIMMUNE DISEASE AFTER ONE YEAR FOLLOW UP
Sisca Silvana,Irawan Mangunatmadja,Damayanti Rusli Sjarif,Dina Muktiarti,Riwanti Estiasari,Darma Imran,M Sidik,Luh Karunia Wahyuni
Department of Child Health Faculty of Medicine Universitas Indonesia Jakarta Indonesia Department of Child Health, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia Department of Neurology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia Department of Ophtalmology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
Background : Autoimmune diseases caused by our immune system attacks healthy cells in our body by mistake. It can affect many parts of the body. Autoimmune diseases in children are generally rare and when they occur they can be challenging to diagnose and difficult to treat.
Case Presentation Summary : A 10 years old Indonesian boy presented with weakness on the right extremities since 1 year ago and followed by all other extremities in 6 months. He complained pain in the vertebra that spreads to the head and produces severe headache. Clinical examination revealed decreased of muscle tone, loss of sight, hearing loss, drooling and lisp, interference of memory, incontinence of urine and alvi. We performed routine blood test, EEG, EMG, BERA, lumbar puncture, oligoclonalband, VEP, SSEP, clinical exome sequencing, MRI whole spine and MRI Brain. All of the examination surprisingly showed normal limit except BERA shown severe sensory neural hearing loss bilateral. MRI Brain result only showed left hippocampal atrophy with no sclerotic at hippocampus, no massa or pathologic lesion at both hemisfer cerebri. At the first time, his ANA test was positive but changed to negative on re-examination. Unfortunately, all this findings were not in line with his declining clinical symptoms that occurred within one year. The result of his clinical exome sequencing has not come out yet so far. We suspected this patient with autoimmune disease therefore we gave him methyl prednisolone high dose for 3 cycles and azathioprine to suppress immune system of this patient.
Learning Points/Discussion : We found different findings between various examinations and clinical manifestations that declining day by day. We suspected multiple sclerosis at the first time but the result of laboratory findings and MRI did not support this. We realized some of neurology cases are difficult to diagnose and treat therefore multidisciplinary team approach are needed.
Keywords: autoimmune regression children