The Co-Occurrence of Astrocytoma and Neuromyelitis Optica Spectrum Disorder in a Child-A Diagnostic Dilemma

Sudarshawn Damodharan,Chrysant

Abstract

Astrocytomas (ACs) are common central nervous system (CNS) neoplasms in the pediatric population. Neuromyelitis optica spectrum disorder (NMOSD) is a rare autoimmune demyelinating childhood condition affecting the CNS. This case represents the first known cooccurrence of both of these disease processes in a pediatric patient. Both conditions have overlapping neurologic symptoms and radiographic features that could potentially mimic one another. Our patient initially presented with a seizure with brain imaging confirming a mass within her left frontal lobe. Surgical resection of the mass was done with histopathology significant for a highgrade astrocytoma, which our patient received treatment for with chemo-radiotherapy. Later, her symptoms progressed to involve acute onset vision loss in her left eye causing our differential diagnosis to expand and leading to confirmation of NMOSD. Subsequent immunosuppressive treatments led to complete restoration of her vision and resolution of her neurologic symptoms. Consequently, the initial diagnosis was revisited and changed to a concurrent low-grade astrocytoma and NMOSD through extensive evaluation and testing.