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Multiple evanescent white dot syndrome masquerading as atypical optic neuritis: a case report
Kwang Eon Han1, Seung Min Lee1, Su-Jin Kim2
1Department of Ophthalmology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, 20, Geumo-ro, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, 50612, South Korea.
Journal of Medical Case Reports
|February 22, 2025
Summary
Multiple evanescent white dot syndrome can mimic optic neuritis, especially when presenting with disc swelling and visual defects. Advanced imaging techniques like OCT and autofluorescence are crucial for accurate diagnosis.
Area of Science:
- Ophthalmology
- Neuro-ophthalmology
Background:
- Multiple evanescent white dot syndrome (MEWDS) is a rare posterior uveitis.
- MEWDS can present with transient retinal white dots, often not visible at diagnosis.
- It may mimic optic neuritis due to overlapping symptoms like visual field defects and disc swelling.
Purpose of the Study:
- To report a case of MEWDS presenting as atypical optic neuritis in a young female.
- To highlight the diagnostic challenges and the role of advanced imaging in differentiating MEWDS from optic neuritis.
Main Methods:
- Case presentation of a 23-year-old female with unilateral ocular pain and visual field defect.
- Diagnostic workup included visual acuity, pupillary response, fundus examination, fluorescein angiography, MRI, multifocal electroretinogram, fundus autofluorescence, en face OCT, and swept-source OCT.
- Diagnosis of MEWDS was confirmed based on clinical findings and imaging results.
Main Results:
- The patient presented with symptoms suggestive of atypical optic neuritis, including disc swelling and a relative afferent pupillary defect.
- Fluorescein angiography showed hyperfluorescent spots and disc leakage.
- Advanced imaging revealed characteristic findings of MEWDS: hyperautofluorescent lesions, hyporeflective dots on en face OCT, and irregular ellipsoid zone changes on swept-source OCT.
Conclusions:
- MEWDS with disc swelling, ocular pain, and RAPD can be misdiagnosed as optic neuritis.
- En face OCT, blue-light fundus autofluorescence, and swept-source OCT are valuable tools for the differential diagnosis of atypical optic neuritis.
- Early and accurate diagnosis of MEWDS is essential for appropriate management and visual recovery.
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