Acquired Esotropia, Focal Seizure, and Subdural Hemorrhage (SDH) in a newly diagnosed moderate hemophilia B child: a case report

Introduction: This case report is relevant to clinicians across multiple disciplines, especially in resource-limited settings, as it illustrates how careful non-surgical management can lead to favorable outcomes in complex bleeding conditions. It could guide future case management, especially for pediatricians and hematologists.Case Presentation: We present the case of a 2-year and 4-month-old male Ethiopian child who was newly diagnosed with moderate hemophilia B and developed esotropia, focal seizures, and subdural hemorrhage after a fall. The surgery was deferred because of the high risk of bleeding, and he was successfully managed with factor IX (FIX), and the child was discharged with a full recovery. Currently, the child is 4 years and 6 months old, and he is active without any apparent focal neurological deficits or seizures. The child is on regular follow-up and does not require any further interventions except for factor IX (FIX) transfusion.Conclusions: This is the first case report describing a newly diagnosed child with Hemophilia B presenting with acquired esotropia, subdural hemorrhage, and focal seizure. Despite the presence of mass effects, the patient was successfully treated with factor IX replacement therapy, avoiding the need for neurosurgical intervention.