Combined hyperacute outer retinal dysfunction and optic neuritis in a paediatric patient: a case report

A 5-year-old male presented to Cairo University Pediatric Ophthalmology and Strabismus (CUPS), Cairo University, Cairo, Egypt, with sudden bilateral loss of vision over 10 days, preceded by a recent upper respiratory infection. The patient was suspected of having bilateral neuromyelitis optica. Initial findings included poor visual acuity—Hand Motion (OD) and LogMAR 1.7 (OS)—bilateral sluggish pupillary reactions, temporal optic disc pallor, and abnormal flash visual evoked potentials without delay. Optical coherence tomography revealed macular thinning with outer retinal IS/OS junction disruption. Neuroimaging (MRI brain and spine), lumbar puncture for oligoclonal bands, and serological anti-MOG antibody were negative, excluding neuromyelitis optica. Coronavirus disease 2019 antispike antibody was positive. The patient received systemic steroids and vision improved within 2 months. Subsequently, nyctalopia developed, and fundus examination showed bilateral retinal mottling and vascular attenuation. Follow-up flash visual evoked potentials responses improved, but full-field electroretinography revealed extinguished responses. The case was diagnosed as optic neuritis associated with Hyperacute Outer Retinal Dysfunction, possibly as a post-coronavirus disease sequela. This report highlights the complexity of vision loss in children and emphasizes the role of multimodal imaging and electrophysiology in diagnosis.