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Published on: April 14, 2014
SARS-CoV-2 Parainfectious Optic Neuropathy: 3 Case Reports and a Review of the Literature
Jeffrey A Gluckstein1, Bart K Chwalisz, Aubrey L Gilbert
1Neuro-ophthalmology (JAG, BKC, MAB), Massachusetts Eye and Ear, Boston, Massachusetts; Neurology (BKC), Massachusetts General Hospital, Boston, Massachusetts; Ophthalmology and Neuro-Ophthalmology (ALG), Kaiser Permanente Vallejo Medical Center, Vallejo, California; and Neuro-Ophthalmology (MAB), Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Background:
Parainfectious optic neuritis is an inflammatory reaction that occurs shortly after an infection without direct invasion by a pathogen. The clinical profile depends on the infectious organism. Cases of SARS-CoV-2 parainfectious optic neuritis have been reported in the literature, but there are no reviews that have applied strict inclusion criteria to more definitively establish the clinical profile associated with SARS-CoV-2.
Methods:
We present 3 new cases of SARS-CoV-2 parainfectious optic neuritis. We also review the literature for definite cases by selecting only those with unambiguous clinical features and MRI findings of optic neuritis, positive SARS-CoV-2 polymerase chain reaction or serology, and the absence of myelin oligodendrocyte-glycoprotein or aquaporin-4 antibodies or other diseases associated with optic neuritis.
Results:
We report 2 cases of monophasic, unilateral SARS-CoV-2 parainfectious optic neuritis with optic disc edema and nadir visual acuities of finger counting. We report 1 case of mild SARS-CoV-2 parainfectious optic neuritis that featured cotton wool spots, peripapillary wrinkles and hemorrhages, and recurrence after an initial steroid taper. We identified 6 cases of unambiguous SARS-CoV-2 parainfectious optic neuritis from the literature. Combining our case series with the case reports in the literature, the average age was 42.8 years, 3/9 had bilateral disease, 6/8 had optic disc edema, 8/9 had nadir visual acuity of finger counting or worse, and all recovered visual acuity to 20/40 or better after therapy with steroids.
Conclusions:
SARS-CoV-2 parainfectious optic neuritis has a clinical profile that is atypical for idiopathic optic neuritis but fairly typical of parainfectious forms of optic neuritis with a severely reduced nadir visual acuity, high likelihood of bilaterality, high incidence of optic disc edema, and prompt and significant response to corticosteroids. Further study with long-term follow-up and epidemiologic investigation will be needed to further characterize this clinical entity.
Insights
This study defines the clinical profile of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) parainfectious optic neuritis, finding it often presents with severe vision loss and optic disc edema. Prompt steroid treatment leads to significant visual recovery in most patients.
Area of Science:
- Neuroscience
- Ophthalmology
- Infectious Diseases
Background:
- Parainfectious optic neuritis occurs after infection without direct pathogen invasion.
- While SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) parainfectious optic neuritis cases exist, reviews with strict criteria are lacking.
- This study aims to define the clinical profile of SARS-CoV-2 parainfectious optic neuritis.
Conclusions:
- SARS-CoV-2 parainfectious optic neuritis presents with severe vision loss, optic disc edema, and potential bilaterality.
- The condition responds well to corticosteroids, with significant visual recovery.
- Further research is needed to fully characterize this clinical entity and its long-term outcomes.
