Abstract Details

Title Atypical Presentation of Optic Neuritis in a Patient With Active Hepatitis C Infection

Topic Neuro-ophthalmology/Neuro-otology

Presentation(s) P5 - Poster Session 5 (11:45 AM-12:45 PM)

Poster/Presentation
Number 17-012

Objective To report a rare case of bilateral optic neuritis associated with untreated, active Hepatitis C virus (HCV) infection, highlighting the diagnostic and therapeutic challenges of a multiple sclerosis (MS) mimic in patients presenting with atypical optic neuritis.

Background Optic neuritis is usually linked to demyelinating conditions like MS, but atypical features such as bilateral involvement of the optic nerves or systemic symptoms necessitate consideration of broader differential diagnoses.

Design/Methods N/A

Results A 50-year-old male with untreated HCV (viral load 9.3 million IU/mL, genotype 3A) presented with progressive vision loss, retro-orbital headaches, nausea, imbalance, tinnitus, and 20-pound weight loss. On ophthalmologic exam bilateral optic disc edema (right: grade 4, left: grade 2), (right eye: counting fingers, left eye: 20/50), macular edema, and intermediate/posterior uveitis. Neurological exam showed brisk reflexes (3+), glove-and-stocking sensory loss, with preserved vibration/proprioception. CSF studies showed lymphocytic pleocytosis, low glucose, elevated protein, elevated myelin basic protein (24.5 ng/mL), 9 oligoclonal bands, and elevated IgG index (1.81). MRI confirmed bilateral optic neuritis/perineuritis; brain MRI was unremarkable. Infectious and autoimmune panels were negative except for HCV and positive ANA (1:640). Treatment with Intravenous Immunoglobulin (IVIG) was chosen to avoid risk of exacerbating infection with corticosteroids. The patient showed partial improvement in visual symptoms. Following extensive workup, the patient's bilateral optic neuritis was most likely related to HCV-associated neuroinflammation, with follow-up for HCV treatment.

Conclusions This case expands the spectrum of MS mimics by demonstrating bilateral optic neuritis as a potential manifestation of chronic HCV infection. It emphasizes the necessity of considering infectious etiologies in the workup for atypical optic neuritis, as well as the challenges associated with managing multiple sclerosis mimics.

Authors/Disclosures
Divya Sharma, MD, MBBS PRESENTER	Dr. Sharma has nothing to disclose.
Oreoluwa E. Morakinyo, MBBS (University of Texas Medical Branch)	Dr. Morakinyo has nothing to disclose.
Vijaya Lakshmi Valaparla, MD	Dr. Valaparla has nothing to disclose.
Chilvana V. Patel, MBBS, FAAN	Dr. Patel has nothing to disclose.

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