A 21-year-old male presented with spastic
quadriparesis, developed gradually over months. He
had no pain or restricted movement of neck. Other
than features of upper-motor-neuron-lesion of all four
limbs, physical examination revealed, multiple Caféau-
lait macules (>2cm in diameter) [Fig. 1], bilateral
a. Dr. Ahmad Mursel Anam, Chief Resident, ICU, Square
Hospitals Ltd., 18/F, BU QaziNuruzzamanSarak, Dhaka
1205, Bangladesh.
b. Dr. Farzana Shumy, Medical Officer, Department of
Internal Medicine, BangabandhuSheikh Mujib Medical
University. Shahbagh, Dhaka-1000, Bangladesh.
c. Prof. M A Jalil Chowdhury, Professor and Chairman,
Department of Internal Medicine, BangabandhuSheikh
Mujib Medical University. Shahbagh, Dhaka-1000,
Bangladesh.
Address of Correspondence: Dr. Ahmad Mursel Anam, Chief
Resident, ICU, Square Hospitals Ltd., 18/F, BU Qazi Nuruzzaman
Sarak, Dhaka 1205, Bangladesh. Cell: +880-1911-010841, Email:
murselanam@gmail.com
axillary freckles [Fig. 2], multiple subcutaneous
neurofibroma [Fig. 3] scoliosis, and a tender soft tissue
mass at right lower chest. Chest x-ray postero-anterior
view showed scoliosis, extrathoracic soft tissue shadow
with invasion of the pleural space, consistent with
plexiform neurofibroma, rib notching and “twistedribbon”
ribs[Fig. 4]. Based on clinical and radiological
findings, he was diagnosed as neurofibromatosis type
1. MRI of spine revealed multiple neurofibromas, at
cervical and dorsal levels. He was offered neurosurgical
management. But he decided for treatment at local
health-facility, and was lost to follow-up.