Teaching NeuroImage: Rapid Identification of Infectious Optic Neuritis by Next-Generation Sequencing.

Abstract

A 52-year-old, HIV-negative woman presented with one year of bilateral painless central vision loss that worsened over 3 months. A medical examination revealed Argyll Robertson pupil (i.e., accommodates but does not react to light). Single-read next-generation sequencing (NGS) of the CSF identified 89 sequence reads corresponding to Treponema, elevated CSF protein, pleocytosis, negative antiaquaporin-4, antimyelin oligodendrocyte glycoprotein antibody levels, retinal nerve fiber layer thinning, and bilateral nerve sheath enhancement (Figures 1–2). The patient received penicillin and oral prednisolone, which improved her vision. Infectious causes of optic neuritis are complex (Table).1,2 NGS is an emerging method with the potential to rapidly identify atypical optic neuritis.