A man in his 50s with a history of hypertension and sleep apnea presented with a 6-week history of progressive, bilateral vision loss while receiving treatment with oral steroids and amoxicillin-clavulanate from his primary care physician. He also had associated ear pain, hearing loss, and severe headaches.
On presentation, his visual acuity was light perception OD and 20/600 at 1 m OS. The right eye had a 1+ afferent pupillary defect. He also had ear drainage with inflamed tympanic membranes and ear tubes in place bilaterally. A dilated fundus examination revealed grade 2 optic disc edema with an inferior disc hemorrhage in the right eye and grade 1 edema in the left eye. The remainder of the examination was unremarkable.
Cossack M, Vanam S, Wallace B. Vision Loss With Pachymeningeal Enhancement on Magnetic Resonance Imaging. JAMA Ophthalmol. 2017;135(5):495–496. doi:10.1001/jamaophthalmol.2016.4542
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