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Obstetrics & Gynecology 2001;98:902-904
© 2001 by The American College of Obstetricians and Gynecologists
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CASE REPORTS

Optic Neuritis With Transient Total Blindness During Lactation

Matthew G. Retzloff, MD, Erik J. Kobylarz, MD, PhD and Cynthia Eaton, MD

Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, and Departments of Obstetrics and Gynecology and Neurology, Darnall Community Hospital, Ft. Hood, Texas

Address reprint requests to: Matthew G. Retzloff, MD, Harvard Medical School, Brigham and Women’s Hospital, 75 Francis Street, ASBI-3, Boston, MA 02115; E-mail: mretzloff{at}partners.org.

BACKGROUND: Lactation-induced blindness is a rare but devastating puerperal complication. There are few reported cases and no consistent associated disease processes historically identified. This case illustrates lactation-associated optic neuritis as an early identifier of multiple sclerosis.

CASE: A nulliparous woman underwent a term vaginal delivery complicated only by chorioamnionitis. She was treated with intravenous antibiotics, which included spontaneous bacterial endocarditis prophylaxis. Her postpartum course was uncomplicated, and she was discharged on postpartum day 2 with her infant. She was readmitted on postpartum day 16 completely blind. Evaluation revealed bilateral optic neuritis. Symptoms were initiated and exacerbated during nursing. Transitory waxing and waning of her visual deficits were noted after aggressive steroid therapy and discontinuing nursing. The patient was subsequently diagnosed with multiple sclerosis of relapsing-remitting type.

CONCLUSION: Multiple sclerosis must be considered as an etiology for acute puerperal lactation-associated blindness when there is no clear anatomic or infectious cause.






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