title: Optic nerve involvement in a borderline lepromatous leprosy patient on multidrug therapy.
abstract: Amidst the plethora of ocular complications of leprosy, involvement of the posterior segment or optic nerve is extremely rare. The mechanism of optic neuritis in leprosy is poorly understood. A 47 year-old man presented with a single lesion suggestive of mid-borderline (BB) leprosy over left periorbital region; the histology showed borderline lepromatous (BL) leprosy with a BI of 3+. After initial improvement with WHO MDT-MB and prednisolone (40 mg/d) he developed sudden and painless diminished vision in the left eye, about 3 weeks later. His visual acuity was 6/9 in the left and 6/6 in the right eye, and there was left optic disc edema, hyperemia and blurred disc margins. Treatment with prednisolone (60 mg/d) along with WHO MDT-MB continued. A month later he returned with painless diminished vision in the other eye as well. Visual acuity was 6/6 in the right and 6/12 in the left eye, and there was right optic disc edema and left optic disc atrophy. CT of the head and MRI of the brain were normal. Inflammatory edema of the orbital connective tissue or other surrounding structures, or direct infiltration of vasa nervosa with resultant vascular occlusion leading to optic nerve ischemia, seems the most plausible explanation of optic nerve involvement in this case.
authors.forename: Neel
authors.initials: N
authors.lastname: Prabha
authors.forename: Vikram K
authors.initials: VK
authors.lastname: Mahajan
authors.forename: Surinder K
authors.initials: SK
authors.lastname: Sharma
authors.forename: Vikas
authors.initials: V
authors.lastname: Sharma
authors.forename: Pushpinder S
authors.initials: PS
authors.lastname: Chauhan
authors.forename: Karaninder S
authors.initials: KS
authors.lastname: Mehta
authors.forename: C
authors.initials: C
authors.lastname: Abhinav
authors.forename: Gaytri
authors.initials: G
authors.lastname: Khatri
authors.forename: Bal
authors.initials: B
authors.lastname: Chander
authors.forename: Rajiv
authors.initials: R
authors.lastname: Tuli
mesh_terms: D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D002991:Clofazimine / Q000008:administration & dosage; D003622:Dapsone / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D006801:Humans; D007194:India; D007917:Leprostatic Agents / Q000627:therapeutic use*; D015439:Leprosy, Borderline / Q000188:drug therapy / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009887:Ophthalmoscopy; D009898:Optic Disk / Q000473:pathology; D009900:Optic Nerve / Q000473:pathology*; D011239:Prednisolone / Q000008:administration & dosage*; D012293:Rifampin / Q000008:administration & dosage; D014792:Visual Acuity; D058609:Visual Field Tests
chemical_list: D000893:Anti-Inflammatory Agents; D007917:Leprostatic Agents; D003622:Dapsone; D011239:Prednisolone; D002991:Clofazimine; D012293:Rifampin