Abnormal movements in children and human African trypanosomiasis: An almost forgotten couple

We reported the case of an 11-year-old girl admitted to the Department of Neurology of the teaching hospital in Bouake for a walking disorder along with long-lasting fever that had gradually developed over two years. The anamnesis revealed a stay in the Ivory Coast, an area endemic for trypanosomiasis. Physical examination showed axial dystonia, abnormal movements of the hands, extra-pyramidal hypertonia, archaic reflexes, daytime sleepiness and nocturnal agitation. The brain computed tomography showed hypodensity of the subcortical white matter. The three different rapid diagnostic tests for trypanosomiasis were positive and the parasitological examination (mAECT) found trypanosomes in the blood. The lumbar puncture presented a clear cerebrospinal fluid containing 30 trypanosomes. NECT (nifurtimox–eflornithine combination therapy) was given for 10 days. Clinical follow-up was favorable with the regression of extrapyramidal symptoms. However, behavioral disorders persisted. This case illustrates that in our clinical setting and despite nearly complete eradication, human African trypanosomiasis remains the main etiology of abnormal mouvements, despite in our clinical setting.