Optic atrophy secondary to minocycline-induced idiopathic intracranial hypertension

Abstract

An early adolescent female presented with blurry vision, ocular ‘fullness’, pulsatile tinnitus and gait difficulty due to poor vision. She was found to have florid grade V papilloedema, 2 months after the use of minocycline for the treatment of confluent and reticulated papillomatosis for 2 months. MRI of the brain without contrast showed fullness of the optic nerve heads concerning for increased intracranial pressure, which was confirmed on lumbar puncture with an opening pressure greater than 55 cm H2O. She was initially started on acetazolamide, but due to high opening pressure and severity of visual loss, a lumboperitoneal shunt was placed in 3 days. This was complicated by a shunt tubal migration 4 months later, leading to worsening vision of 20/400 in both eyes for which she underwent shunt revision. By the time she presented to the neuro-ophthalmology clinic, she was legally blind with her exam consistent with bilateral optic atrophy.