Steroid-Resistant Double-Seronegative Optic Neuritis Responds Favorably to Plasma Exchange

The clinical presentation of optic neuritis is quite characteristic, and the epidemiology, differential diagnosis, and treatment protocol are well established. However, when the presentation of optic neuritis is atypical, bilateral, and intravenous steroid-resistant, the treatment guidelines are qui...

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Bibliographic Details
Published inCurēus (Palo Alto, CA) Vol. 13; no. 5
Main Authors Mason, Matthew C, Marotta, Dario A, Kesserwani, Hassan
Format Journal Article
LanguageEnglish
Published Palo Alto (CA) Cureus 26.05.2021
Subjects
Internal Medicine
Neurology
Ophthalmology
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Summary:The clinical presentation of optic neuritis is quite characteristic, and the epidemiology, differential diagnosis, and treatment protocol are well established. However, when the presentation of optic neuritis is atypical, bilateral, and intravenous steroid-resistant, the treatment guidelines are quite nebulous. We present a case of bilateral severe double-seronegative optic neuritis with catastrophic vision loss and intravenous steroid resistance. After an exhaustive investigation, we empirically treated our patient with plasma exchange therapy and obtained a dramatic recovery of vision. When an immune etiology is suspected, this case is instructive vis-a-vis the utility of plasma exchange in refractory cases of optic neuritis despite seronegativity.
ISSN:2168-8184
2168-8184
DOI:10.7759/cureus.15260