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‘The worm that got away’: parainfectious atypical optic neuritis associated with schistosomiasis infection
  1. Chinar Osman1,
  2. Sally Hannigan1,
  3. Adam Ditchfield1,
  4. Stephen Harden2,
  5. Ben Marshall3,
  6. Ashwin Arnold Pinto1
  1. 1Neurosciences Department, Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
  2. 2Department of Cardiothoracic Radiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
  3. 3Department of Respiratory Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK
  1. Correspondence to Dr Chinar Osman, Neurosciences Department, Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 1YD, UK; Chinar.osman{at}uhs.nhs.uk

Abstract

Although optic neuritis is commonly associated with multiple sclerosis, patients with atypical optic neuritis require further investigations to exclude other associated conditions. We report a woman presenting with cough, fatigue, atypical optic neuritis with chiasmitis. She responded partially to corticosteroids and we subsequently found she had a ground-glass lung nodule. Follow-up CT scan of thorax at 12 months showed new parenchymal lung lesions that suggested schistosomiasis. Further questioning by a respiratory physician identified, in retrospect, a previous exposure history; serological testing confirmed schistosoma infection. She was treated with praziquantel and slowly improved clinically, with radiological improvement in the optic chiasm, regression of the parenchymal lung lesions but with the ground glass nodule unchanged. We diagnosed parainfectious optic neuritis associated with schistosomiasis, based upon exposure history, serological confirmation and radiological features, together with the response to treatment, and having excluded other causes of an atypical optic neuritis.

  • TROPICAL NEUROLOGY
  • INFECTIOUS DISEASES
  • NEUROIMMUNOLOGY
  • NEUROOPHTHALMOLOGY
  • TROPICAL MEDICINE

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