Parainfectious optic neuritis followed by microcystic macular oedema

Abstract

Parainfectious optic neuritis is a very rare cause of acute vision loss. We present a case of a 51-year-old man with a recent upper respiratory tract infection, presumably of viral aetiology, who showed up with complains of painless right eye vision loss, followed by the same symptoms on the left eye 3 weeks later. Ophthalmological examination revealed optic disc swelling (sequential in severity) which was confirmed by optic disc imaging. The remaining evaluations (lumbar puncture, MRI, laboratory and genetic testing) were completely normal. Considering a postviral aetiology, 5-day intravenous methylprednisolone treatment was performed. Follow-up examinations revealed slight visual acuity and visual fields recovery, with subsequent optic disc atrophy and microcystic macular oedema, bilaterally. This case illustrates how important a correct clinical history is to guide a correct diagnosis and posterior management.

Bilateral Parainfectious Optic Neuritis in Young Patient

“…Optic neuritis in Malaysia shows 50% of aetiology related to infection [ 4 ]. Parainfectious optic neuritis is defined as the involvement of the optic nerve that occurs after presumably or confirmed systemic infectious disease and is highly associated with viral aetiology [ 5 ]. Gender predilection in parainfectious optic neuritis is seen more in female predominance, especially after puberty.…”

“…Parainfectious optic neuritis can occur at any age and is usually caused by pathogens such as mycoplasma pneumonia, Varicella-zoster virus (VZV), rubella, mumps, and rarely, Epstein-Barr virus (EBV) [ 7 ]. The most frequent cause is a viral infection, but it is not always possible to identify the causal organism [ 5 ]. Extension from adjacent meningitis or orbital disease can cause direct infection of the optic nerve.…”

“…Moreover, there is no consensus regarding therapy for parainfectious optic neuritis [ 7 ]. Intravenous methylprednisolone pulse therapy is known to have a good visual prognosis, with or without antiviral coverage as well [ 5 ]. Among authors, the widest recommendation; cases of unilateral paediatric optic neuritis are conservative, while for bilateral with severe vision loss are to be treated with a short dosage of intravenous methylprednisolone (15 mg/kg/day for three days).…”

Bilateral optic neuritis with macular edema in a young female: A case report

“…7 Retinal microcystic macular oedema has been linked to several optic neuropathies-besides MS, neuromyelitis optica, Leber's hereditary optic neuropathy, dominantoptic atrophy, isolated relapsing optic neuropathy, parainfectious optic neuropathy and glaucoma. 8 Optic neuritis may occur at any age, but clinical characteristics differ by age group. In children, bilateral presentation is most frequent (60%-70%).…”

“…1 Parainfectious optic neuritis is defined when optic nerve involvement occurs after presumably/ confirmed systemic infectious disease, particularly of viral aetiology. 2 Inflammation of optic nerve might be caused by direct invasion of the nerve by viruses and bacteria, as an immune response triggered by systemic infections and central nervous system infections. Differential diagnosis of optic neuritis is varied and extensive due to the presence of various etiologies.…”