Abstract
Severe acute respiratory syndrome coronavirus-2 (SARS-Cov-2) may cause various neuro-ophthalmologic manifestations including optic perineuritis. Optic perineuritis is a rare form of orbital inflammatory disease in which optic nerve sheath is inflamed and nonspecific fibrotic thickening with classic radiological finding is a perineural enhancement of optic nerve sheath.A 45-year-old gentleman with known diabetes mellitus, hypertension and dyslipidemia was admitted with a critically ill COVID-19 infection. During the recovery period, the patient developed sudden onset of painless loss of vision. MRI head and orbit with gadolinium was suggestive of optic perineuritis. Other secondary causes of autoimmune or vasculitis myelin oligodendrocyte glycoprotein (MOG) antibody disease and other common central nervous system (CNS) infection were excluded. The patient had dramatic response with steroids.This is the first rare case report of COVID-19-related optic perineuritis in critically ill COVID-19 patients with seronegative MOG antibody. Optic perineuritis is a rare orbital inflammatory disease and underlying mechanisms may arise from systemic response to COVID-19 infection as well as direct effects of the virus via angiotensin-converting enzyme 2 (ACE-2) receptors on ocular tissues. Optic perineuritis is a rare disease with inflammation restricted to the optic nerve sheath. Neuroimaging of the brain and orbit is the most important modality of choice for visualizing optic nerve sheath and optic nerve. Delay in the diagnosis of COVID-19-related optic perineuritis, may result in permanent optic nerve injury and irreversible vision loss.
Highlights
Severe acute respiratory syndrome coronavirus-2 (SARS-Cov-2) is a new genus of beta coronavirus that may cause visual impairment due to dacryoadenitis, conjunctivitis, tonic pupils, vitritis, central retinal artery or venous occlusion, retinitis, retinal bleeding, panuveitis, anterior ischemic optic neuropathy (AION), optic perineuritis, optic neuritis and occipital ischemic stroke [1].The optic nerve carries greater than one million axons that derive from retinal ganglion cells and are projected to the visual nuclei [2]
Optic perineuritis is a rare form of orbital inflammatory disease in which optic nerve sheath is inflamed and nonspecific fibrotic thickening with classic radiological finding is a perineural enhancement of optic nerve sheath
In the review of present literature on optic perineuritis associated with COVID-19 infection and vaccination, there were two case reports, the first was associated with seropositive myelin oligodendrocyte glycoprotein (MOG) antibody and the other perinuclear anti-neutrophil cytoplasmic antibodies (P-anti-neutrophil cytoplasmic autoantibodies (ANCA))-associated post BNT162B2 mRNA COVID-19 vaccination, suspected of underlying autoimmune mechanism and responded effectively to immunotherapy
Summary
Severe acute respiratory syndrome coronavirus-2 (SARS-Cov-2) is a new genus of beta coronavirus that may cause visual impairment due to dacryoadenitis, conjunctivitis, tonic pupils, vitritis, central retinal artery or venous occlusion, retinitis, retinal bleeding, panuveitis, anterior ischemic optic neuropathy (AION), optic perineuritis, optic neuritis and occipital ischemic stroke [1]. CRP: C-reactive protein; LDH: lactate dehydrogenase; HbA1c: glycated hemoglobin; ALT: alanine aminotransferase; AST: aspartate aminotransferase; CPK: creatine phosphokinase; NT-pro BNP: N- terminal pro B-type natriuretic peptide; C3: complement component 3; C4: complement component 4; ANCA: antineutrophil cytoplasmic autoantibody; DAT: direct antiglobulin test; CSF: cerebrospinal fluid; PCR: polymerase chain reaction; HHV: human herpesvirus; ANA: antinuclear antibody; CMV: cytomegalovirus; TSH: thyroid-stimulating hormone; MOG: myelin oligodendrocyte glycoprotein; HSV: herpes simplex virus; CCP: cyclic citrullinated peptide; VSV: varicella-zoster virus. He was transferred to the rehabilitation center for the critical illness myopathy physical therapy and follow-up neuro-ophthalmology clinic after 3 months
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