Open AccessSuccessful treatment of bilateral visual loss caused by HIV-associated optic neuritis
Author(s) -
Claire Cullen,
Baile Matlala,
Fatima Laher,
Ané Pienaar
Publication year - 2011
Publication title -
southern african journal of hiv medicine
Language(s) - English
Resource type - Journals
eISSN - 2078-6751
pISSN - 1608-9693
DOI - 10.4102/sajhivmed.v12i4.169
Subject(s) - medicine , optic neuritis , methylprednisolone , prednisone , syphilis , cytomegalovirus , visual acuity , magnetic resonance imaging , surgery , multiple sclerosis , human immunodeficiency virus (hiv) , gastroenterology , immunology , radiology , viral disease , herpesviridae
Optic neuritis is not an uncommon diagnosis in HIV-infected patients, but it is rarely idiopathic. We report a case of a young HIV-infected woman who developed optic neuritis as her presenting manifestation of HIV infection. She had initially experienced sudden-onset right-sided painful visual loss; the left eye had become involved within days. Bilateral swollen discs were apparent on fundoscopy. Investigations were performed for meningitis (including bacterial, cryptococcal, tuberculous and syphilitic types), auto-immune diseases, toxoplasma, rubella, cytomegalovirus, viral hepatitis, HTLV-1/2, HIV-1/2 and syphilis. The only positive result was a reactive HIV enzyme-linked immunosorbent assay. The CD4 count was 85 cells/µl. A post-contrast magnetic resonance imaging scan of the brain illustrated enhancement of the optic nerves. Treatment was 3 days of intravenous methylprednisolone 1 g daily, followed by 11 days of oral prednisone 60 mg daily. Highly active antiretroviral therapy was initiated after 2 weeks. Vision improved from day 6 after commencement of steroid therapy, with ongoing recovery at 5 months