Case Presentation:
A 30-year-old Kenyan lady who is medically free presented to our hospital with right eye blurry vision that started one week before admission and gradually progressed over one day to complete right eye vision loss. Her condition was associated with mild right eye pain, which was exacerbated by eye movement. Her left eye was normal. She denied any previous similar episodes; she gave no history of any focal weakness or sensory abnormalities. She had no headache, no dizziness, and no abnormal body movements. She reported no fever. She did not have any history of head trauma, and she denied any urinary or defecation difficulties. On further questioning, the patient elaborated that she had an episode of gastroenteritis a week before admission. She has been given IV Metronidazole 500 mg (one dose) and discharged on Pantoprazole PO 40 mg daily and Metoclopramide tablets 10 mg as needed for nausea and vomiting. The day after her discharge, she started complaining of decreased eye vision which progressively worsened to complete vision loss in one day; she did not seek medical advice due to financial issues. Upon admission, her vital signs were normal(Body Temperature: 36.7 Celsius degrees, Heart Rate: 78 beats per minute, Blood Pressure: 117/70 mmHg, SPO2: 98% on room air). She had unremarkable chest and abdominal examinations. A central nervous system examination showed normal higher mental status. Normal power, tone, reflexes, coordination, and normal sensory function. Her gait was normal. Her cranial nerves examination showed complete loss of vision in her right eye, otherwise unremarkable. Her right eye ophthalmologic examination was significant for right afferent pupillary defect and optic disc edema with the normal macula with normal left eye examination. Her Complete blood count, serum electrolytes, renal function, liver function tests, thyroid function test, and B12 level were all normal. Her Head Computed Tomography was unremarkable.
Lumbar Puncture was done and Cerebrospinal fluid (CSF) analysis showed WBC of 44/ul (Normal range 1-5/ul), 97% lymphocytic, RBC 2/ul (Normal range 0-2/ul), Glucose 2.90 mmol/l (Normal range 2.22-3.89 mmol/l) and protein of 0.65 gm/l (Normal range of 0.15-0.45 gm/l). CSF was negative for culture and viral panel as well as oligoclonal bands. Her MRI brain and orbit MRI confirmed right optic neuritis. ( figure 1 The patient was started on IV Methylprednisolone 1000 mg daily for five doses. She showed a slight improvement in her eyesight from nil to hand movement at a 50 cm distance on discharge. Follow up visits at one week and two months after discharge for the patient showed that her vision stabilized at “close counting fingers” level with no further improvement.