Mary Czarina V. San Diego,
Erwin D. Palisoc
Department of Ophthalmology - Jose R. Reyes Memorial Medical Center
This is a case of an apparently healthy young male who presented with sudden loss of vision on the left eye, followed by progressive blurring of vision on the right eye associated with ocular pain. No comorbidities and no other symptoms. Social history revealed that the patient is homosexual practicing oral and anal intercourse with multiple partners. The patient had visual acuity of 20/125 on EDTRS on the right eye and no light perception on the left eye. Relative afferent defect was noted on the left eye. Fundoscopy initially showed normal then progressed to blurred disc margins on both eyes. Laboratory exams done were unremarkable except for positive HIV antibody and optic neuritis on MRI. Intravenous steroids for 3 days shifted to oral for 11 days given provided improvement to best corrected visual acuity of 20/20 on the right and 20/50 on the left eye. Seven months later, the vision is still maintained and the patient has been on HIV treatment.
All cases of atypical optic neuritis should be suspected to have underlying HIV infection. Optic neuritis may be the initial and only manifestation in an HIV patient. This case reports a case of optic neuritis with no other clinical manifestations in HIV, which is alarming in the Philippines given its high prevalence of HIV cases.