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A case of anti-aquaporin 4 antibody positive optic neuritis treated by plasma exchange therapy Mai Nishida-Hamada 1 , Momoko Yamakawa 1 , Mai Ueda 1 , Yuichi Yoshida 1 , Emiko Muroyama 1 , Shinsuke Miyahara 1 , Takayuki Kondo 2,3 , Teruyo Tanabe 1 1Department of Ophthalmology, Tazuke Kofukai, Medical Research Institute, Kitano Hospital 2Department of Neurology, Tazuke Kofukai, Medical Research Institute, Kitano Hospital 3Department of Neurology, Kansai University Medical Center pp.1296-1303
Published Date 2020/10/15
DOI https://doi.org/10.11477/mf.1410213710
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Abstract Purpose:We report a case of anti-aquaporin 4(AQP4)antibody positive optic neuritis in the optic chiasma and tract that responded well to additional plasma exchange therapy(PE)in early stage.

Case:A 65-year-old woman had frequent hiccups and vomiting of undetermined cause since 3 months before for 2 months. She visited our hospital with acute impaired vision since late July. Corrected visual acuity was 0.1 in the right eye and 0.09 in the left. Central critical fusion frequency(CFF)was 35 Hz in the right and 25 Hz in the left. Optic disc swelling was not observed. Bitemporal hemianopia and nasal lower visual field defect in the left eye was present by Goldmann perimetry. Magnetic resonance imaging(MRI)showed contrast enhancing lesion in the chiasm and left side tract. On FLAIR MRI imaging, high intensity lesion was observed around fourth ventricle. After one course of steroid pulse therapy proved invalid, she received PE with oral steroid treatment. Serological test was positive for anti-AQP4 antibody, leading to the diagnosis of anti-AQP4 antibody positive optic neuritis. Visual field and CFF started to improve after the second PE, visual acuity after the fourth PE. There has been no recurrence of disease after seven sessions of PE followed by oral steroid treatment.

Conclusion:For optic neuritis that is resistant to steroid pulse therapy and is suspected as anti-AQP4 antibody seropositive by clinical and MRI findings, we recommend additional plasma exchange in early stage.


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