Relapsing-remitting, corticosteroid-sensitive, varicella zoster virus optic neuritis.
We report a 13-year-old male who presented with bilateral disc edema after a febrile illness. Rapid loss of vision prompted corticosteroids treatment, which reversed the visual loss and optic disc findings. Both his visual function and disc edema proved exceedingly sensitive to steroids, and he required increasingly slow and prolonged corticosteroids taper to avoid relapse over a period of 1 year. Ultimately, profound visual loss was reversed three times and only after exceptionally slow steroid weaning. Comprehensive systemic investigations and neuroimaging were initially unrevealing. Late in the course of disease, evidence of seroconversion was identified in his serum and cerebrospinal fluid with positive varicella zoster virus antibodies titers. Varicella zoster virus-related optic nerve pathology may present clinically with profound visual loss and disc edema and may reverse only with high-dose corticosteroids treatment. Physicians should carefully consider retesting with late varicella zoster virus titer in patients with relapsing-remitting, steroid-sensitive optic neuritides.
Pless
Misha L
ML
Departments of Ophthalmology, Neurological Surgery, and Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
Malik
Saleem I
SI
D000293:Adolescent; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D002908:Chronic Disease; D005938:Glucocorticoids / Q000627:therapeutic use*; D014645:Herpesvirus 3, Human / Q000187:drug effects; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D009900:Optic Nerve / Q000473:pathology / Q000821:virology; D009902:Optic Neuritis / Q000188:drug therapy* / Q000821:virology*; D011241:Prednisone / Q000627:therapeutic use; D012008:Recurrence; D014786:Vision Disorders / Q000821:virology
D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D011241:Prednisone; D008775:Methylprednisolone