A 17-year-old previously healthy girl presented with 3 months of decreased vision in the right eye associated with throbbing pain with eye movement. The patient had no history of weakness, incontinence, or severe headaches. Initial presentation was notable for hand motion visual acuity with a 2+ relative afferent pupillary defect on the right; fundus examination revealed grade IV disc edema with obscuration of all major vessels on the disc (Figure, A). A magnetic resonance image (MRI) of the brain with and without gadolinium contrast was degraded by motion and orthodontic artifact but was suggestive of optic nerve enhancement consistent with optic neuritis. Results of serology tests and cerebral spinal fluid analysis were negative for infectious and inflammatory etiologies, including syphilis, sarcoidosis, Lyme disease, viral etiologies, multiple sclerosis, and lupus.
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Corresponding Author: Katherine J. Williams, MD, Department of Ophthalmology, Baylor College of Medicine/Cullen Eye Institute, 1977 Butler Blvd, 2nd Floor, Houston, TX 70030 (email@example.com).
Published Online: November 18, 2021. doi:10.1001/jamaophthalmol.2021.1466
Conflict of Interest Disclosures: Dr Allen has received personal fees from Horizon Pharma. No other disclosures were reported.
Additional Contributions: We thank the patient’s mother for granting permission to publish this information.
Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:
It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.
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