Case Report: Severe Optic Neuritis after Multiple Episodes of Malaria in a Traveler to Africa

Abstract

Although local transmission of malaria has been eliminated, the disease is frequently imported to China by Chinese travelers returning from Africa. Optic neuritis (ON) is occasionally reported in malarial cases and usually shows good visual recovery and prognosis. Herein, we report severe visual loss with poor recovery due to bilateral ON in a malarial patient who traveled from Nigeria. While he was still in Nigeria, his visual acuity dropped to no light perception in both eyes after the third episode of malaria, which was confirmed by a positive blood smear for malarial parasites. His general condition gradually improved after a 6-day course of artesunate therapy. However, visual acuity in both eyes remained unchanged after artesunate therapy alone, with gradual improvement subsequently shown after pulse steroid therapy. Our case indicates that early antimalarial drugs combined with pulse steroid therapy may be of great importance for good visual recovery in ON cases after malarial infection.

Case Report: Optic neuritis as the initial presentation of Orientia tsutsugamushi infection detected by metagenomic next-generation sequencing

“…Moreover, TBA revealed an intracellular antineuronal autoantibody in the serum of the patient, but no responsible autoantibodies such as antinuclear antibodies were detected in this study. Hence, more investigations including paraneoplastic syndrome and autoimmune encephalitis autoantibody test need to be done to exclude whether there exists a currently unknown antineuronal autoantibody in this case ( 14 , 27 , 29 ).…”