Bilateral optic neuropathy following vincristine chemotherapy: A case report with description of multimodal imaging findings.

RATIONALE A few cases of optic neuropathy presumed to be caused by vincristine have been reported. However, none described multimodal imaging findings. Here, we report abnormal magnetic resonance imaging (MRI) and optical coherence tomography (OCT) findings in a putative case of vincristine-induced optic neuropathy. PATIENT CONCERNS A 9-year-old boy with Burkett lymphoma who had had no visual problems noticed blurred vision in both eyes 22 days after the first maintenance therapy for lymphoma; the blurred gradually worsened. At that time, the best-corrected visual acuity was 20/200 and 20/100 in the right and left eyes, respectively. DIAGNOSES Blood and imaging workup, and cerebrospinal fluid and genetic analyses, were performed; these included fundus photography, OCT, and MRI. We found no plausible cause of the optic neuropathy other than vincristine. INTERVENTIONS The scheduled chemotherapy was stopped, and the patient was managed with high-dose corticosteroids. However, as there was no improvement, plasma exchange was then performed. OUTCOMES Three days after the initial examination, the visual acuity in both eyes was only light perception and projection. Signal intensity was abnormally high on 3-dimensional T2-weighted turbo spin echo and T2-weighted MRI images. Optic disc atrophy progressed to "total pallor"; thinning of the ganglion cell-inner plexiform and retinal nerve fiber layers also progressed. The patient was followed up for 7 months but showed no improvement in vision. There were no treatment-related complications. LESSONS We conclude that vincristine can cause optic neuropathy, and clinicians need to be alert to the possibility of optic neuropathy in any patient prescribed this agent.OCT and MRI may help to diagnose optic neuropathy in pediatric patients. Periodic ophthalmologic examinations, including an OCT scan, may be useful.