Bilateral optic disc swelling as the presenting sign of pheochromocytoma in a child

Bilateral optic disc swelling in children is a relatively uncommon sign with a wide array of differential diagnoses. We describe a boy with bilateral optic disc swelling referred as a case of papilledema. However, upon careful ocular fundus examination, detection of discrete retinal nerve fiber layer and pigment epithelial changes at a distance from the optic discs raised the probability of malignant hypertension. This was confirmed by a simple blood pressure measurement. Judicious medical control of the hypertension and a full systemic evaluation led to successful surgical treatment of the inciting pheochromocytoma. A thorough history and meticulous clinical examination are irreplaceable, powerful diagnostic tools that can correctly direct the plan of management, thus preventing unnecessary investigations and delays or potentially serious complications.