title: 'The worm that got away': parainfectious atypical optic neuritis associated with schistosomiasis infection.
abstract: Although optic neuritis is commonly associated with multiple sclerosis, patients with atypical optic neuritis require further investigations to exclude other associated conditions. We report a woman presenting with cough, fatigue, atypical optic neuritis with chiasmitis. She responded partially to corticosteroids and we subsequently found she had a ground-glass lung nodule. Follow-up CT scan of thorax at 12 months showed new parenchymal lung lesions that suggested schistosomiasis. Further questioning by a respiratory physician identified, in retrospect, a previous exposure history; serological testing confirmed schistosoma infection. She was treated with praziquantel and slowly improved clinically, with radiological improvement in the optic chiasm, regression of the parenchymal lung lesions but with the ground glass nodule unchanged. We diagnosed parainfectious optic neuritis associated with schistosomiasis, based upon exposure history, serological confirmation and radiological features, together with the response to treatment, and having excluded other causes of an atypical optic neuritis.
authors.affiliation: Neurosciences Department, Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
authors.forename: Chinar
authors.initials: C
authors.lastname: Osman
authors.affiliation: Neurosciences Department, Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
authors.forename: Sally
authors.initials: S
authors.lastname: Hannigan
authors.affiliation: Neurosciences Department, Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
authors.forename: Adam
authors.initials: A
authors.lastname: Ditchfield
authors.affiliation: Department of Cardiothoracic Radiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Harden
authors.affiliation: Department of Respiratory Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
authors.forename: Ben
authors.initials: B
authors.lastname: Marshall
authors.affiliation: Neurosciences Department, Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
authors.forename: Ashwin Arnold
authors.initials: AA
authors.lastname: Pinto
mesh_terms: D000305:Adrenal Cortex Hormones; D000328:Adult; D005260:Female; D006801:Humans; D009103:Multiple Sclerosis; D009902:Optic Neuritis / Q000150:complications* / Q000175:diagnosis; D012552:Schistosomiasis / Q000150:complications* / Q000175:diagnosis
chemical_list: D000305:Adrenal Cortex Hormones
keywords: INFECTIOUS DISEASES; NEUROIMMUNOLOGY; NEUROOPHTHALMOLOGY; TROPICAL MEDICINE; TROPICAL NEUROLOGY