DR.ROHAN BASAK

Dr. STEPHEN SUDHAKAR, DR. ADITHYA TELLAKULA

Abstract

A 34 year old female presented with headache for the last 3 months associated with painful sequential diminution of vision in the left eye followed by right eye. She was diagnosed as a case of bilateral optic neuritis elsewhere. Visual acuity was perception of light in the right eye and hand movements in the left eye. There was bilateral disc edema with no response to steroids. Contrast-enhanced CT PNS showed bony erosions in the sphenoidal sinus. Contrast MRI Brain showed infiltrates along bilateral optic nerves and in planum sphenoidale. Patient was HLA B-51 positive. She underwent left pterional craniotomy and debulking of the lesions. Histopathology was positive for IgG4 with atypical CNS angitis. She was started on monthly Cyclophosphamide injections. After receiving her fourth dose of Cyclophosphamide, her visual acuity was stable in the right eye and improved to counting fingers at 1 meter in the left eye. Disc edema had resolved and temporal pallor had set in.