Optic neuritis, as unusual manifestations of hypoparathyroidism: a rare case report

Optic neuritis, commonly associated with multiple sclerosis (MS), can also occur in the context of hypocalcemia as a rare intriguing clinical scenario. Most recent articles have reported the association of papilledema and hypoparathyroidism, However, very rarely, case reports revealed hypocalcemia-induced optic neuritis as well as our case.

We report a 43-year-old woman with a history of hypocalcemia presenting with optic neuritis, characterized by sudden vision loss, painful eye movements, and pulsatile headache. Despite the normalization of serum calcium level and pulses of steroid treatment for the most probable underlying cause (demyelination); visual acuity improvement was not regained. Lumbar puncture revealed normal intracranial pressure, and MRI showed unspecific periventricular signal changes with T1 hyperintensity in bilateral basal ganglia and thalamic mostly in favor of calcifications. Additional investigations ruled out alternative conditions like multiple sclerosis and other inflammatory-based disorders.

Optic neuritis could have an association with hypocalcemia, with or without elevated intracranial pressure, which highlights the necessity for comprehensive evaluations in patients with visual symptoms despite normal intracranial pressure. While serum calcium correction effectively treats papilledema, its benefit for optic neuritis remains unclear. Further evaluations are needed to understand the exact pathology and optimal management of hypocalcemia-related optic neuritis.