SHM Converge Scientific Abstract ePoster Gallery-Challenges in the Diagnosis and Management of Atypical Optic Neuritis in an Elderly Patient

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This document summarizes a difficult case of atypical optic neuritis in an 86-year-old woman with hypertension and hyperlipidemia who presented with sudden, painless vision loss in the right eye. Because giant cell arteritis was initially suspected, she was started on high-dose IV methylprednisolone. However, a temporal artery biopsy was negative, and MRI findings later raised concern for atypical optic neuritis.<br /><br />Her hospital course became more complicated when she developed a new temporal lobe infarct and a painless vesicular rash on her lower back, raising concern for viral reactivation, including varicella-zoster virus or herpes simplex virus. The case highlights how optic neuritis in older adults is uncommon and requires a broad differential diagnosis, including vascular, infectious, autoimmune, malignant, and demyelinating causes.<br /><br />Extensive testing did not reveal a clear underlying cause, illustrating the diagnostic uncertainty that can occur in elderly patients with atypical optic neuritis. The authors emphasize that diagnosis and management often require close collaboration among neurology, ophthalmology, infectious disease, and dermatology. The case also illustrates an important complication of high-dose immunosuppression: it can increase the risk of viral reactivation and other adverse events.<br /><br />Overall, the report underscores that atypical optic neuritis in patients over 50 is rare, complex, and challenging to diagnose, especially when multiple possible causes overlap and initial testing is unrevealing. The authors argue that more research is needed to better understand the mechanisms, improve diagnostic clarity, and optimize treatment strategies for this condition.

Asset Subtitle

Elena Valentyn

Meta Tag

Author List Elena Valentyn, Pinky Jha

Category Clinical Vignettes

Concept Atypical Optic Neuritis

Concept Acute Painless Vision Loss

Concept Differential Diagnosis

Concept Optic Neuropathy

Concept Multimodal Workup

Distinguished Non-Finalist

Presenter Organization Medical College of Wisconsin

Presenting Author Elena Valentyn

Track Adult

Keywords

atypical optic neuritis

elderly patient

sudden vision loss

giant cell arteritis

temporal artery biopsy

temporal lobe infarct

varicella-zoster virus

herpes simplex virus

high-dose corticosteroids

diagnostic uncertainty

Atypical Optic Neuritis

Acute Painless Vision Loss

Differential Diagnosis

Optic Neuropathy

Multimodal Workup