# Bilateral Optic Neuritis as the Initial Presentation of Acute HIV Infection in a Young Bodybuilder: A Case Report

## TL;DR

A young bodybuilder with bilateral optic neuritis was found to have acute HIV infection, showing that optic issues can signal underlying infections.

## Contribution

This case report adds a rare instance of acute HIV presenting as bilateral optic neuritis in a young man with high-risk behaviors.

## Key findings

- Bilateral optic neuritis was diagnosed in a young man with acute HIV-1 infection.
- The patient improved with corticosteroids and antiretroviral therapy.
- The case emphasizes considering HIV in atypical optic neuritis presentations.

## Abstract

Background and Clinical Significance: Optic neuritis, an inflammatory demyelinating condition affecting the optic nerve, can present as an isolated phenomenon or as a harbinger of an underlying systemic disorder. While often associated with multiple sclerosis (MS), optic neuritis has been reported in the context of various infectious and inflammatory conditions, including human immunodeficiency virus (HIV) infection. Case Presentation: We describe a case of bilateral optic neuritis that led to the diagnosis of acute HIV infection in a young man actively engaged in bodybuilding, anabolic steroid use, and high-risk sexual behavior. The patient initially presented with an acute onset of vision loss, headache, and photophobia. Magnetic resonance imaging (MRI) findings confirmed demyelination of the optic nerves, and laboratory workup revealed acute HIV-1 infection. The patient improved following high-dose corticosteroids and initiation of antiretroviral therapy. Conclusions: This case highlights the need to consider systemic infections such as HIV in atypical presentations of optic neuritis.