title: Leber's hereditary optic neuropathy masquerading as optic neuritis with spontaneous visual recovery.
abstract: We report a case of Leber's hereditary optic neuropathy (LHON) masquerading as optic neuritis with late visual recovery. A 28-year-old man had gradual visual loss in both eyes for two weeks. Visual acuity was 0.4 in the right eye and 0.7 in the left. Fundus examination revealed hyperaemic discs in each eye. Fluorescein angiography revealed dye leakage at both optic discs in the late phase. Static perimetry (Humphrey 30-2) revealed bilateral relative central scotomata. Magnetic resonance imaging of the optic nerves was normal and his lumbar puncture showed normal opening pressure. He received steroid pulse therapy for three days. Nevertheless, vision in his right eye deteriorated to 0.1 one month later and left vision worsened to 0.05 six months later. Fifteen months after onset, his vision began to improve. At 21 months, his vision recovered to 0.9 R and 1.0 L. Peripheral blood DNA sequencing revealed 14484 mutation of mitochondrial DNA (mtDNA). Visual recovery can occur in patients with Leber's hereditary optic neuropathy with mtDNA 14484 mutation. LHON could be misdiagnosed as optic neuritis in some cases. Molecular examination of mtDNA mutation can confirm the diagnosis of LHON in clinically controversial patients. We should keep in mind the diagnosis of LHON when optic neuritis shows poor response to pulse therapy.
authors.affiliation: Department of Ophthalmology, Cheng Hsin General Hospital, Taipei, Taiwan, Republic of China.
authors.forename: Tsui-Kang
authors.initials: TK
authors.lastname: Hsu
authors.forename: An-Guor
authors.initials: AG
authors.lastname: Wang
authors.forename: May-Yung
authors.initials: MY
authors.lastname: Yen
authors.forename: Jorn-Hon
authors.initials: JH
authors.lastname: Liu
mesh_terms: D000328:Adult; D004272:DNA, Mitochondrial / Q000235:genetics; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D029242:Optic Atrophy, Hereditary, Leber / Q000175:diagnosis* / Q000188:drug therapy* / Q000235:genetics; D009902:Optic Neuritis / Q000175:diagnosis*; D020551:Pulse Therapy, Drug; D020127:Recovery of Function / Q000187:drug effects*; D013256:Steroids / Q000008:administration & dosage*; D014794:Visual Fields
chemical_list: D004272:DNA, Mitochondrial; D013256:Steroids
keywords: Leber's hereditary optic neuropathy; mtDNA 14484 mutation; optic neuritis papilloedema; visual recovery