A case of acute macular neuroretinopathy in a pediatric patient with optic neuritis

TL;DR

A 14-year-old boy with optic neuritis also developed acute macular neuroretinopathy, a rare condition typically seen in adults.

Contribution

This is the first reported case of AMG-associated optic neuritis with AMN in a pediatric patient.

Findings

Optic neuritis in a 14-year-old boy was accompanied by acute macular neuroretinopathy.

The patient was diagnosed with MOG antibody-associated disease.

Post-treatment, visual acuity improved, but a paracentral scotoma remained.

Abstract

Acute macular neuroretinopathy (AMN) is a retinal disorder caused by ischemia in the deep capillary plexus. There have been several reports of AMN associated with optic neuritis in adults. We report a case of AMN associated with optic neuritis in a pediatric patient.

A 14-year-old boy presented with ocular pain upon eye movement and decreased vision with disc edema in the right eye, leading to a diagnosis of optic neuritis. After initiating steroid pulse therapy, his visual acuity improved promptly. Optical coherence tomography revealed a hyperreflective area in the outer retina on the nasal side of the macula, and fundus examination showed a reddish-brown, wedge-shaped lesion, confirming the diagnosis of AMN. The case was ultimately diagnosed as myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease. Post-treatment, visual acuity improved; however, a paracentral scotoma attributed to AMN remained.

The pathogenesis of AMN in cases of optic neuritis may involve mechanical arterial occlusion due to optic disc swelling. Regardless of age, careful fundus examination is necessary during the clinical course of optic neuritis, and MOG-immunoglobulin G testing can be considered for patients showing optic neuritis with AMN.

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