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Toxic optic neuropathy: case report A 30-year-old man developed toxic optic neuropathy (TON) during treatment with chloramphenicol and ciprofloxacin for osteomyelitis. The man, who had osteomyelitis, had been receiving chloramphenicol and ciprofloxacin [dosages and routes not stated]. He presented with a 1-week history of progressive painless loss of vision in both eyes associated with impairment of colour vision. On day 8 of the illness, clinical examination showed best corrected visual acuity of 6/18 in right and 6/12 in the left eye. His colour vision reduced in both the eyes (more in right eye than left). Fundus examination showed bilateral mild blurring of disc margins and mild tortuosity of retinal vessels at posterior pole. Visual field test revealed bilateral centro cecal scotoma. Visual evoked potentials noted prolonged P-100 latency bilaterally. Optical coherence tomography demonstrated retinal nerve fibre layer thickness on the higher side. A contrast enhanced magnetic resonance imaging of the brain including orbit and CSF analysis was unremarkable. Based on these findings, a suspected diagnosis of TON secondary to chloramphenicol and ciprofloxacin was made [duration of treatments to reaction onset not stated]. The man’s treatment with chloramphenicol and ciprofloxacin was discontinued. He was treated with high doses of B vitamins comprising B12, B6 and folic acid, which resulted in improvement of symptoms. At a 3-month follow-up, his visual acuity and bilateral colour vision were normal. Radhakrishnan D, et al. Toxic optic neuropathy- An uncommon complication of commonly used antibiotics. Journal of the Neurological Sciences 405 (Suppl.): 262, 15 Oct 803446290 2019. Available from: URL: http://doi.org/10.1016/j.jns.2019.10.1300 [abstract]

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Reactions 18 Jan 2020 No. 1787