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Relapsing-remitting, corticosteroid-sensitive, varicella zoster virus optic neuritis
Misha L Pless1, Saleem I Malik
1Departments of Ophthalmology, Neurological Surgery, and Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
Pediatric Neurology
|December 20, 2003
Summary
Varicella zoster virus can cause optic nerve inflammation and vision loss. Prompt corticosteroid treatment is crucial for recovery, with careful steroid tapering needed to prevent relapses.
Area of Science:
- Ophthalmology
- Neurology
- Infectious Diseases
Background:
- Optic neuritis is inflammation of the optic nerve, often causing vision loss.
- Recurrent optic neuritis can be challenging to manage, particularly in younger patients.
Observation:
- A 13-year-old male presented with bilateral disc edema and rapid vision loss after a febrile illness.
- Initial investigations, including neuroimaging, were inconclusive.
- The patient experienced recurrent vision loss despite corticosteroid treatment, requiring a slow steroid taper over one year.
Findings:
- Varicella zoster virus (VZV) seroconversion was identified late in the disease course.
- VZV-related optic nerve pathology was confirmed as the underlying cause.
- Profound visual loss was reversed multiple times with high-dose corticosteroids.
Implications:
- Varicella zoster virus should be considered in cases of relapsing-remitting, steroid-sensitive optic neuritis.
- Late VZV antibody testing in serum and cerebrospinal fluid may be diagnostically valuable.
- High-dose corticosteroids are essential for managing VZV-related optic nerve pathology, with careful management of steroid withdrawal to prevent recurrence.