DR. MOHINI AGRAWAL

DR.ROLLI KHURANA, DR.(MAJ) SHANKAR SANDEEP

Abstract

Infectious atypical optic neuritis (AON) like tubercular is a vision threatening condition with phenotypic overlap with Neuromyelitis Optica Spectrum Disorder (NMOSD). The overlapping neurological manifestations and negative AQP4-Ab-assay make it difficult to discover the primary cause of neuritis.

Two paediatric cases are reported with NMOSD that do not fulfil the diagnostic criteria. Associated undiagnosed tuberculosis at the time of presentation and negative AQP4-Ab clouded the diagnosis and delayed the treatment.

First case was initially diagnosed with infectious optic neuropathy. By the time steroids started, optic atrophy had set in. Second case had Optic neuritis, LETM and intracranial-tuberculomas with no signs of pulmonary-tuberculosis with negative CSF-analysis. So, systemic steroids were started promptly. The history of LETM in both cases raised the suspicion of NMOSD. This emphasizes on the importance of accurate clinical diagnosis and early intervention in cases of AON.