Relapsing–Remitting Multiple Sclerosis in a Nigerian Woman: Diagnostic and Therapeutic Challenges in a Low-Resource Setting
Adekunle MUSTAPHA *
Department of Medicine, Ben Carson College of Health and Medical Sciences, Babcock University, Ilishan Remo, Ogun State, Nigeria.
Oluwadamilola Opeyemi ADENEKAN–OKONJI
Department of Internal Medicine, Babcock University Teaching Hospital, Ilishan Remo, Ogun State, Nigeria.
Anthony Ifechukwu OKONJI
Department of Radiology, Babcock University Teaching Hospital, Ilishan Remo, Ogun State, Nigeria.
*Author to whom correspondence should be addressed.
Abstract
Background: Multiple sclerosis (MS) is a chronic immune-mediated demyelinating disorder of the central nervous system that is increasingly recognised in sub-Saharan Africa. Diagnostic and treatment delays remain common because of a low index of suspicion, limited access to neuroimaging, overlap with infectious and degenerative neurological disorders, and limited availability of medication.
Case Presentation: We report the case of a 43-year-old Nigerian woman who presented with a three-year history of recurrent lower limb paraesthesia and stiffness, followed by the subacute onset of visual blurring and right facial paraesthesia. Neurological examination was largely unremarkable. Magnetic resonance imaging (MRI) of the brain demonstrated multiple periventricular, deep white matter, pontine, and cerebellar peduncular T2/FLAIR hyperintense lesions with characteristic Dawson’s fingers. Cerebrospinal fluid analysis revealed positive oligoclonal bands (type 2). Whole-spine MRI showed extensive multilevel degenerative disc disease with spinal canal stenosis, as well as features consistent with demyelinating pathology. A diagnosis of relapsing–remitting multiple sclerosis was made based on the 2017 McDonald criteria. The patient showed significant clinical improvement following corticosteroid therapy. Although interferon beta-1a (Avonex) was advised as disease-modifying therapy, access was limited because of its unavailability.
Conclusion: This case highlights the diagnostic complexity of multiple sclerosis in low-resource settings, particularly when extensive degenerative spine disease coexists. Increased awareness and early utilisation of MRI and CSF analysis are important for prompt diagnosis of MS, while limited treatment resources may affect outcomes in Nigeria.
Keywords: Multiple sclerosis, relapsing–remitting multiple sclerosis, demyelination, oligoclonal bands, magnetic resonance imaging, Dawson’s fingers, degenerative spinal disease, disease-modifying therapy, low-resource setting