Clinical Reasoning: An Immunocompetent Young Adult With Acute Vision Loss.
Aviv Fineberg, Axel Petzold, Mark A Hellmann et al.
✦ AI-curated · Sources linked
Case in brief
A 23-year-old male presented with worsening headaches, bilateral retrobulbar pain, and blurred vision. Evaluation indicated bilateral optic neuritis, with MRI, CSF analysis, and blood tests showing normal results except for elevated liver enzymes and cytomegalovirus-immunoglobulin G titers. Treatment with intravenous methylprednisolone led to rapid improvement in vision, despite concerns of a systemic viral infection.
Diagnostic / clinical pearl
Clinicians should consider the possibility of infectious causes of optic neuritis, especially in the presence of elevated liver enzymes and cytomegalovirus titers.
Why it matters
This case underscores the importance of differentiating between demyelinating and infectious causes of optic neuritis to guide appropriate management.