Clinical Reasoning: An Immunocompetent Young Adult With Acute Vision Loss.

Authors

Aviv Fineberg, Axel Petzold, Mark A Hellmann, Iliya Simantov, Yamit Cohen-Tayar, Omer Y Bialer, Hadas Stiebel-Kalish

Published in

Neurology. Volume 107. Issue 8. Pages e218553. Oct 27, 2026. Epub Sep 25, 2026.

Abstract

A 23-year-old male patient presented to the emergency department with several days of exacerbating headaches, bilateral retrobulbar pain, and blurred vision. Ophthalmologic evaluation was consistent with bilateral optic neuritis (ON). MRI, CSF analysis, and blood tests were normal except for elevated liver enzymes and elevated cytomegalovirus-immunoglobulin G titers. Prompt treatment with intravenous methylprednisolone for acute ON was initiated, despite the concern for an acute systemic viral infection, resulting in rapid improvement in vision. This case report highlights the key differentiating findings and management between demyelinating, infectious, and para-infectious ON.

PMID:
42789817
Bibliographic data and abstract were imported from PubMed on 26 Sep 2026.

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