Blindness, Weakness, and Tingling

A previously healthy 50-year-old man complained of acute bilateral loss of vision over 24 hours associated with tingling of his hands and feet. During the first 48 hours of hospitalization, he evolved quadriplegia, facial diplegia, bulbar palsy, and respiratory distress requiring ventilator assistance. At the same time vision deteriorated to hand motions. Lumbar puncture, electromyography, and clinical findings were all consistent with Guillain-Barré syndrome. The diagnosis of concomitant bilateral optic neuritis was made. Tests for immunological, inflammatory, infectious, or genetic diseases were unremarkable. Within weeks, repeated treatments with intravenous immunoglobulin, plasmapheresis, and high-dose parenteral corticosteroids led to resolution of motor findings, although visual acuity improved only to 20/100 OD and count fingers at 6 feet OS. Guillain-Barré syndrome-associated optic neuritis is rare and may be associated with an underlying Mycoplasma pneumoniae infection.