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CC BY 4.0 · Arq Neuropsiquiatr 2024; 82(S 01): S1-S52
DOI: 10.1055/s-0044-1789331
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Silent bilateral optic papillitis after COVID-19: a case report

Juliana Santiago-Amaral
1   Instituto de Previdência dos Servidores de Minas Gerais, Belo Horizonte MG, Brazil.
,
Lucas Alexandre Santos Marzano
1   Instituto de Previdência dos Servidores de Minas Gerais, Belo Horizonte MG, Brazil.
,
Vinicius Rezende Avelar
1   Instituto de Previdência dos Servidores de Minas Gerais, Belo Horizonte MG, Brazil.
,
Jéssica Resende Vaz de Melo
1   Instituto de Previdência dos Servidores de Minas Gerais, Belo Horizonte MG, Brazil.
,
Izabela Cristina de Faria Martins
1   Instituto de Previdência dos Servidores de Minas Gerais, Belo Horizonte MG, Brazil.
,
Rodrigo Kleinpaul
1   Instituto de Previdência dos Servidores de Minas Gerais, Belo Horizonte MG, Brazil.
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    Address for correspondence: Juliana Santiago-Amaral (email: julimss@gmail.com).

    Abstract

    Case Presentation: A 23-year-old female patient presented bilateral optic papilla edema in a routine ophthalmological consultation, without related complaints or neurological deficits. She had bilateral eyelid edema and redness, had been diagnosed with COVID-19, confirmed by the PCR method, and shown spontaneous improvements two months before. She was previously myopic, without other comorbidities or use of medications. A neurological evaluation showed normal visual acuity, no color vision deficiencies or marked visual field defects, and other neurological deficits were absent. Cerebral and orbital magnetic resonance imaging scans were normal, even as cerebrospinal fluid analysis. Optical coherence tomography (OCT) and ultrasonography excluded optic nerve drusen. Differential diagnosis investigation showed non-reactive anti-aquaporin 4 antibody and myelin oligodendrocyte glycoprotein antibodies, and the metabolic, rheumatological, and infectious screenings were also normal. The patient was diagnosed with bilateral papillitis, possibly triggered by SARS-CoV-2 infection. No acute or prophylactic treatment was started. Two years after the diagnosis, the fundus remained stable.

    Discussion: The present case report aims to demonstrate an atypical manifestation of neurological alteration after SARS-CoV-2 infection. There are no similar reports in the Brazilian literature. Among the few cases described, the diagnosis was confirmed through clinical history and extensive complementary work-up, and the patients presented significant loss of visual function after infection or vaccination for SARS-CoV-2, requiring corticosteroid therapy as a therapeutic approach, with a good response and almost complete recovery of the deficits in most cases.

    Final Comments: The present case report demonstrates an uncommon occurrence of silent bilateral optic papillitis after SARS-CoV-2 infection, highlighting parainfectious causes as differential diagnosis of multiple diseases that affect the optic nerve, such as multiple sclerosis, neuromyelitis optica spectrum disorders, and myelin oligodendrocyte glycoprotein antibody-associated disease.


     

    No conflict of interest has been declared by the author(s).

    Publication History

    Article published online:
    02 October 2024

    © 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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