Bilateral sequential optic neuropathy as the initial manifestation of Sjögren syndrome.
BACKGROUND
Neuro-ophthalmic findings are uncommon in the setting of Sjögren syndrome. We report the case of a patient with bilateral, sequential optic neuropathy as the initial manifestation of Sjögren syndrome.


METHODS
A 38-year-old male presented with sudden painless visual loss in his left eye in May 2005. Fundus examination revealed a left swollen optic disk. Magnetic resonance imaging (MRI) revealed a left optic nerve lesion. Elevated titres of autoantibodies (ANA, anti-SSA, anti-SSB) were found, suggestive of Sjögren syndrome. In January 2006, he presented with painful sudden visual loss in the right eye. Fundus examination revealed a right swollen optic disk and left optic nerve atrophy. MRI was normal. Other aetiologies were ruled out.


RESULTS
Each episode was treated with intravenous methylprednisolone (1 g/day during 3 days), followed by oral prednisone (1 mg/kg/day). Moderate improvement of vision ensued in both eyes.


CONCLUSIONS
Atypical presentation of an optic neuropathy must raise the suspicion of an unusual aetiology. Our case illustrates how a bilateral sequential optic neuropathy in an otherwise healthy patient can result from an unusual inflammatory aetiology: primary Sjögren syndrome.
Pournaras
J-A C
JA
Jules Gonin Eye Hospital, University of Lausanne, Lausanne, Switzerland.
Vaudaux
J D
JD
Borruat
F-X
FX
D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D004338:Drug Combinations; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*; D009901:Optic Nerve Diseases / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology*; D011241:Prednisone / Q000008:administration & dosage*; D012859:Sjogren's Syndrome / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy*; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D004338:Drug Combinations; D011241:Prednisone; D008775:Methylprednisolone