Proceedings of the 25th BCTRIMS Annual Meeting

Case presentation: A 23-year-old female patient presented bilateral optic papilla edema in routine ophthalmological consultation, without related complaints or neurological deficits. She had bilateral eyelid edema and redness, being diagnosed with COVID-19, confirmed by PCR method, showing spontaneous improvements two months before. Previously myopic, without other comorbidities or use of medications. Neurological evaluation showed a normal visual acuity, no color vision deficiencies or marked visual field defects, others neurological deficits were absent. Cerebral and orbital magnetic resonance imaging were normal, even as cerebrospinal fluid analysis. Optical coherence tomography (OCT) and ultrasonography excluded optic nerve drusen. Differential diagnosis investigation showed non-reactive anti-aquaporin 4 antibody and myelin oligodendrocyte glycoprotein antibodies, metabolic, rheumatological and infectious screening were also normal. The patient was diagnosed with bilateral papillitis, possibly triggered by SARS-CoV-2 infection. No acute or prophylactic treatment was started. Two years after the diagnosis, the fundus remained stable.

Discussion: This case report aims to demonstrate an atypical manifestation of neurological alteration after SARS-CoV-2 infection. There are no similar reports in Brazilian literature. Among the few cases described, the diagnosis was confirmed through clinical history and extensive complementary work-up and the patients presented significant loss of visual function after infection or vaccination for SARS-CoV-2, requiring corticosteroid therapy as a therapeutic approach, with a good response and almost complete recovery of the deficits in the majority of the cases.

Final comments: Our case report demonstrates an uncommon occurrence of silent bilateral optic papillitis after SARS-CoV-2 infection, highlighting parainfectious causes as differential diagnosis of multiple diseases that affect optic nerve as multiple sclerosis, neuromyelitis optica spectrum disorders and myelin oligodendrocyte glycoprotein antibody associated disease.