Abstract General Information



Case Report

Case Presentation: A previously healthy 14-year-old female patient presented with severe visual loss in the left eye (LE) associated with ipsilateral ocular movement pain. The symptoms began 3 days after the onset of COVID-19. Investigation ruled out ophthalmologic, infectious, and rheumatologic causes. Left optic neuritis (ON) was diagnosed, and intravenous methylprednisolone (IVMP) was administered, with partial improvement of symptoms.
After eight months, the patient presented with severe visual loss in the right eye (RE) associated with ocular movement pain, which started 5 days after Pfizer vaccination for COVID-19. IVMP was administered, with partial improvement. Magnetic resonance imaging of the brain and orbits showed hyperintensity in T2 of both optic nerves, more pronounced on the left, without other brain abnormalities. Anti-aquaporin 4 and anti-MOG antibodies were negative.
At the last evaluation, pupils were isocoric and photoreactive, there was relative afferent pupillary defect to the left, visual acuity was 20/400 in the RE and hand motion perception in the LE. Binocular indirect ophthalmoscopy showed mild optic disc pallor bilaterally. The rest of the neurological examination was typical.
Discussion: Optic neuritis (ON) is the inflammation of the optic nerves and can be caused by autoimmunity, infection, paraneoplastic syndrome, granulomatous disease, and demyelinating diseases. Post-COVID and post-vaccination ON is considered a rare clinical event in literature reviews, and most cases described have a good prognosis. We report the case of a teenager who developed left ON while infected with COVID-19, and subsequently right ON associated with the vaccine intake.
Final comments: COVID-19, as well as vaccines developed for its prevention, can be associated with demyelinating diseases of the central nervous system, including ON. Cases of ON triggered by COVID-19 and post-vaccination are rare in the literature. This is the first case described of ON associated with both COVID-19 and post-vaccination in the same patient.


Clinical findings


Juliana Santiago Amaral, Juliana Monção, Ana Cristina Cotta Queiroz, Beatriz Silva Lombardi , Clara Catharino Pinhati, Cleison Sanches Silva, Gabriel Coelho, Denison Pedrosa, Grazielle Fialho de Souza, Hugo Brito, Emerson Costa Oliveira, Felipe Baptista Brunheroto, Lucas Bittar Sesso Freitas, Larissa Ferrarez, Márcia Prates, Natália Cirino Talim, Paulo Pereira Christo, Pedro L. B. dos Reis, Thales Ponsá, Marco Aurélio Lana-Peixoto