Acute persistent bilateral loss of vision

Bilateral severe vision loss is a dramatic illness that requires extended diagnostics and immediate therapy. We report on a 37-year-old man who was admitted with lower back pain, headache, and fever. Within 3 days he developed meningism, pleocytosis in the cerebral spinal fluid, and bilateral vision loss, with the vision loss occurring within a few hours. Magnetic resonance imaging showed swelling of the optic nerves. No signs of infectious or immunologic disease could be detected. Despite antibiotic and antiviral treatment followed by immunosuppression with high-dose methylprednisolone, the patient's symptomatology did not decline. The disease course resulted in bilateral atrophy of the papillae caused by bilateral fulminant optic neuritis.