Pediatric optic neuritis with non-reactive antibodies: case report

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Abstract

Case Presentation: A 10-years-old, male, without comorbidities, evolved with low visual acuity in the right eye and amaurosis in the left eye. The fundoscopy revealed significant bilateral optic disc edema. Brain Tomography and brain Magnetic Resonance Imaging (MRI) were performed, without any abnormalities. Laboratory tests showed reactive cytomegalovirus IgG, positive IgG for Epstein–Barr virus, positive IgM for Zika Virus and high Complement C4, with values of 43mg/ml. In question, Anti-QP-4, Oligoclonal Bands and IgG for MOG were non-reactive.

Discussion: The optic neuritis (OS) is defined as a pathological process characterized by inflammation of one or both optic nerves. The visual prognosis and the risk of recurrent lesions vary depending on their etiology and involvement. Pediatric optic neuritis is usually bilateral and anterior associated with papillitis. It can be associated with viral infection, although the pathogen is rarely identified or can be a manifestation of an acquired demyelinating syndrome. Usually, optic neuritis has a good prognosis in this age group. At this case, the optic neuritis didn't present positive antibodies for MOGAD, Multiple Sclerosis and Neuromyelitis Optica Spectrum Disorder, but as an isolated syndrome. Recognizing the disease can help us to provide a better treatment to the patient and clear prognosis.

Final Comments: Although the patient in question was double seronegative, he had a severe visual loss. Anti-AQP-4 and Anti-MOG antibodies are indispensable in the investigation of pediatric optic neuritis in order to make the differential diagnosis between Multiple Sclerosis, Neuromyelitis Optica Spectrum Disorder and MOGAD. Despite being rare, the optic neuritis can cause serious repercussions in the patient. However, the course of optic neuritis in the pediatric age group usually has a good prognosis. The treatment consists of reducing inflammation and relieving symptoms, in order to improve visual acuity.

Publication History

Article published online:
12 May 2025