An Atypical Presentation of Progressive Multiple Sclerosis in a Young Black Male

Multiple sclerosis (MS) is an autoimmune disease primarily affecting the central nervous system, commonly diagnosed in women and individuals of European ancestry. It most commonly presents in the form of relapsing-remitting MS, which is characterized by exacerbations with partial to complete recovery. Far less common is the primary progressive form of MS, which involves the progression of neurological symptoms that gradually worsen with time. We present an atypical case of progressive MS in a 26-year-old incarcerated Black male. Initially diagnosed in 2019, he experienced bilateral upper extremity weakness and phasic spasticity, with subsequent worsening of symptoms including lower extremity spasticity, vision impairment, and difficulties with mobility and writing. With progressing symptoms, unintentional weight loss, and declining motor function, he was admitted to the hospital in March 2023. This case emphasizes the importance of considering MS as a differential diagnosis in any patient with progressive neurological dysfunction because, unlike the more prevalent relapsing-remitting type of MS, primary progressive MS has a more insidious onset with no recovery between exacerbations. It addresses the patient's symptom history, medication compliance challenges, and the need for improved education and awareness of MS in diverse patient populations.