Introduction Neuromyelitis optica spectrum disorder is a rare autoimmune condition that has the potential to cause both visual and physical disability. Timely diagnosis and treatment are essential to optimize the chance of visual recovery. Ocular sequalae of neuromyelitis optica spectrum disorder are often only one piece of the clinical picture as many organ systems can be affected. This case report presents a positive visual outcome through appropriate workup and prompt referral for treatment. Case Report A 58 year-old Black woman presented with a significant, bilateral decline in visual acuity and light sensitivity. Pertinent systemic conditions include transverse myelitis diagnosed 18 months prior. Ocular examination revealed visual acuity of 5/100 (20/400) in the right eye and 2/700 (20/7,000) in the left eye using a Feinbloom acuity chart, a left afferent pupillary defect, but unremarkable fundus examination. Magnetic resonance imaging with contrast dye confirmed chiasmal enhancement consistent with retrobulbar optic neuritis. The patient was hospitalized and received high-dose intravenous steroids, plasmapheresis, and rituximab infusions. Her visual acuity was restored completely after completing this treatment protocol, and she has not experienced any recurrent episodes. Conclusion This case demonstrates that complete visual recovery in neuromyelitis optica spectrum disorder is achievable despite the patient’s daunting clinical presentation. Although the patient still faces physical challenges related to her diagnosis of transverse myelitis, timely neuroimaging and aggressive treatment minimized lasting visual impairment and reduced the chance for relapse.
Crystal H. Maharrey (Fri,) studied this question.