Bilateral optic neuritis related to chronic inflammatory demyelinating polyneuropathy

Abstract

Chronic inflammatory demyelinating polyneuropathy (CIDP) is a condition that mainly affects the peripheral nervous system; however, the central nervous system has also been involved in rare cases. Herein, we describe the case of a 33-year-old man with CIDP who presented with progressively blurred vision and pain with eye movement in both eyes for 1 month. Ocular examination revealed reduced visual acuities of 0.15 (oculus unitas or OU) and unremarkable fundi (OU). Furthermore, bitemporal visual field defects and prolonged visually evoked potentials were evident. Brain magnetic resonance imaging revealed nothing remarkable along the optic nerve and chiasm. These findings were compatible with the diagnosis of bilateral optic neuritis. The patient's symptoms and visual acuity improved after 5 days of intravenous (IV) corticosteroid pulse therapy, which was subsequently replaced by oral prednisolone therapy with a tapering schedule. The patient's visual acuity returned to 1.0 (OU) 6 months after treatment. However, bilateral optic neuritis recurred in 7 months while the patient was on oral prednisolone and azathioprine. IV corticosteroid pulse therapy was subsequently reinitiated and the patient's visual acuity returned gradually to 1.0 (OU). Bilateral optic neuritis is a rare manifestation of CIDP. It responded well to IV corticosteroid therapy in our case.

Pain in Chronic Inflammatory Demyelinating Polyradiculoneuropathy: A Systematic Review and Meta-Analysis

“…None of the papers included in this review reported on a patient where pain was an isolated symptom. Pain always coexisted with other CIDP features, the most prominent being weakness (reported by 85% of painful CIDP patients) [17–20, 23, 24, 26–31, 33–35, 37, 38, 40–42, 45–50, 52] followed by numbness (reported by 75% of painful CIDP patients) [17, 19, 21–39, 41–50, 52].…”

“…No robust data regarding the effect of treatment for pain in CIDP were available. The effectiveness of CIDP treatment in pain was clearly reported only in 46 patients [17–19, 23–26, 28, 30–35, 37, 41–45, 47–49]. Of those, in 41 patients (89%), treatment for CIDP had reduced pain.…”

Pathogenesis, Clinical and Laboratory Features of Chronic Inflammatory Demyelinating Polyneuropathy

“…В литературе описаны клинические случаи поражения зрительных нервов при ХВДП и развития рассеянного склероза после лечения ХВДП [39]. По данным A. Cortese et al [40], около 36 % пациентов с постинфекционными демиелинизирующими заболеваниями ЦНС имеют признаки вовлечения в процесс периферической нервной системы (ПНС).…”

Anti-Asialo GM1 Antibody–Positive Optic Neuritis and Optic Perineuritis in Chronic Inflammatory Demyelinating Polyneuropathy

“…Visual-evoked potentials were prolonged in 3 patients. All cases were treated with steroids, with improvement in vision at follow-up in all except one case, where vision deteriorated to light perception only (2). Of note, none of the patients had antibody testing, although this is not required by the current diagnostic criteria for CIDP.…”

“…To date, there are no reported cases of CIDP-associated OPN in the literature. However, 6 cases of CIDP-associated ON in adult patients have been reported (involving 11 eyes in total) (2). These patients were aged between 18 and 57 at diagnosis, with 4 men and 2 women.…”