Metastatic Melanoma of the Optic Nerve Sheath

Neil M. D’souzaBaylor College of Medicine, Houston, Texas, USA

Huy D. NguyenBaylor College of Medicine, Houston, Texas, USA

http://orcid.org/0000-0003-1039-3971

Stacy V. SmithDepartment of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas, USA

Priyadharsini NagarajanDepartment of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA

Adi DiabMelanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA

Richard C. AllenSection of Ophthalmology, Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA

Dan S. GombosSection of Ophthalmology, Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA

Andrew G. LeeBaylor College of Medicine, Houston, Texas, USA;Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas, USA;Section of Ophthalmology, Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA;Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, New York, USA;Department of Ophthalmology, University of Texas Medical Branch, Galveston, Texas, USA;Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USACorrespondence[email protected]

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ABSTRACT

A 23-year-old man with a history of metastatic melanoma developed painful vision loss to counting fingers with enhancement of optic nerve on contrast-enhanced magnetic resonance imaging (MRI) and received a diagnosis of optic neuritis from an outside hospital. Despite empiric corticosteroid therapy, the patient worsened and developed secondary central retinal vein occlusion with further deterioration of vision. Repeat MRI demonstrated optic nerve sheath (ONS) involvement suggestive of optic perineuritis (OPN) and an ONS biopsy confirmed a rare case of isolated metastatic melanoma. Our case highlights the clinical and radiographic features that can mimic OPN and delay diagnosis and treatment.

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Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

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Metastatic Melanoma of the Optic Nerve Sheath

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Metastatic Melanoma of the Optic Nerve Sheath

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