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.