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JAMA Ophthalmology Clinical Challenge
December 2015

Optic Nerve Atrophy and Hair Loss in a Young Man

Author Affiliations
  • 1The Retina Institute, St Louis, Missouri
  • 2now with The Retina Associates of South Texas, San Antonio
  • 3Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St Louis, Missouri
JAMA Ophthalmol. 2015;133(12):1469-1470. doi:10.1001/jamaophthalmol.2015.1957

A young man presented for a second opinion regarding acquired color blindness and visual loss. He was recently hospitalized for confusion, short-term memory loss, vomiting, and diarrhea. He also experienced hair loss (Figure 1), a facial rash, hoarseness, and painful peripheral neuropathy in his feet. His blood pressure on admission was 150/102 mm Hg, his pulse was 118 beats/min, and ophthalmic examination findings demonstrated decreased visual acuity and dyschromatopsia. He reported difficulty opening his eyelids during hospitalization but denied any history of diplopia. Results of a complete blood cell count, comprehensive metabolic panel, and erythrocyte sedimentation rate were within reference limits, and computed tomography of the head without contrast showed no abnormalities. A lumbar puncture showed normal opening pressure with a mildly elevated protein level in the cerebrospinal fluid.

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