SHM Converge Scientific Abstract ePoster Gallery-Looking Beyond Optic Neuritis-When Sarcoidosis Presents With Optic Perineuritis

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This case describes optic perineuritis (OPN), a rare inflammatory condition involving the optic nerve sheath that can cause eye pain, blurred vision, and vision loss. OPN is typically diagnosed through clinical findings and MRI, and it may be secondary to systemic diseases such as sarcoidosis, IgG4-related disease, vasculitis, infections, or malignancy. It is not associated with multiple sclerosis, and most patients respond well to corticosteroids.<br /><br />A 44-year-old man with no prior medical history presented with new headaches, acute left eye discomfort, blurred vision, and progressive central vision loss. Examination and labs were largely unrevealing except for a mildly elevated C-reactive protein. Contrast-enhanced brain and orbital MRI showed left optic perineuritis involving the intra-orbital, intra-canalicular, and pre-chiasmatic optic nerve segments.<br /><br />He was treated empirically with high-dose steroids, which improved both his eye symptoms and headache. His history also included a subacute cough and intermittent shortness of breath, prompting further evaluation. Chest CT revealed bilateral pulmonary micronodules and hilar/mediastinal lymphadenopathy. Although serum ACE was normal and autoimmune testing was negative, bronchoscopy with biopsy demonstrated non-necrotizing granulomas with negative AFB stains and no microbial growth, confirming systemic sarcoidosis.<br /><br />The case highlights that optic perineuritis can be the first sign of systemic sarcoidosis and may mimic optic neuritis. When OPN is identified, clinicians should investigate for underlying systemic disease rather than assuming an isolated optic nerve problem.

Asset Subtitle

Hong Yu Wang

Meta Tag

Author List Destiny Nguyen, Hong Yu Wang, Patricia Dharapak, Samuel Tan, Yuhong Yang

Category Clinical Vignettes

Concept Optic Perineuritis

Concept Optic Neuritis

Concept Magnetic Resonance Imaging

Concept Visual Symptoms

Concept Sarcoidosis

Distinguished Non-Finalist

Presenter Organization Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel

Presenting Author Hong Yu Wang

Track Adult

Keywords

optic perineuritis

sarcoidosis

optic nerve sheath inflammation

vision loss

blurred vision

MRI

corticosteroids

granulomas

optic neuritis differential

systemic disease

Optic Perineuritis

Optic Neuritis

Magnetic Resonance Imaging

Visual Symptoms

Sarcoidosis