A 36-year-old male presented to ER with sudden loss of vision in both eyes, associated with sever periorbital pain, photophobia and pain with eye movement. Vision was NLP right eye and 20/70 left eye with a right afferent pupillary defect in the right eye. Eye movements were full. Ishihara color vision was 0/14 right eye and 2/14 left eye. Restricted confrontation visual field in all quadrants right eye. Slit-lamp exam was normal. Orbit and brain MRI showed bilateral inflammation of the optic nerve sheath bilaterally. CT chest was unremarkable, Patient with positive FTA Antibodies in serum. He was treated with IV solumedrol with improvement of his vision to 20/20 in both eyes. Then 2 weeks later on he presented to ER with recurrent episode in the right eye, worsening of vision to NLP in right eye, 20/20 left eye. Repeat MRI Orbit with worsening of right optic nerve sheath inflammation, Lumbar puncture was done with unremarkable CSF. He was given IV solumedrol for 1 week and 2 weeks of IV Penicillin for presumed Tertiary syphilis, his vision improved to 20/20 in both eyes. Still Pending Anti-MOG antibody and Spine MRI.
Presentation Date: 05/21/2020
Issue Date: 08/01/2020
Continuing Medical Education (CME)