Successful outcome of paediatric cytomegalovirus optic neuritis treated with combined steroid and valganciclovir: A case report

Abstract

AbstractPurpose: To report the clinical approach for diagnosis and management of paediatric optic neuritis.Methods: A 13 years old girl patient came to the emergency room with complaints of sudden blurred vision in both eyes and pain with eye movement. On Ophthalmic examination, the visual acuity in the right eye was 6/30 and the left eye was no light perception. There was a positive relative afferent pupillary defect in the left eye. Both the optic disc was swollen. The colour vision was abnormal and there was inferior visual field defect. Laboratory examination showed an increase leukocyte, increase in cytomegalovirus (CMV) immunoglobulin G (IgG) antibody, and decrease in cluster of differentiation 4 (CD4) cell. The head and orbital MRI did not show any intracranial pathological lesion. The patient was diagnosed with optic neuritis caused by CMV and treated with intravenous methylprednisolone 250 mg every 6 h for 3 days followed by oral prednisone 1 mg/kg daily and valganciclovir 16 mg/kg daily for 3 weeks.Results: After 3 days of only intravenous steroid treatment, her visual acuity improved to 6/9 in right eye and 1/300 in left eye. The vision increase significantly to 6/6 in the right eye and 6/7.5 in the left eye after 1 month treated with combined steroid and valganciclovir.Conclusions: A comprehensive examination, includes history taking, optic nerve examination, laboratory and serology tests related to infection, also head and orbital MRI to rule out other causes is important in the management of paediatric optic neuritis. Appropriate treatment with IV methylprednisolone and valganciclovir provide a better visual prognosis for paediatric CMV optic neuritis.