Temporal Variation and Regional Differences in Deaths Related to Guillain-Barré Syndrome (GBS) in the United States: A Retrospective Analysis of Two Decades

A 25-year old female presented with acute deterioration of her vision due to influenza infection.Initially, she reported seeing through a "clear broken dish," followed by seeing varying sizes of "black dots" and "flashing lights" in bilateral visual fields.Of note, she suffered from chronic visual impairment in bilateral visual fields for two years following COVID-19 infection, described as "persistent small black dots."On examination, bilateral pupils measured 3 millimeters with intact pupillary reflex, but there was reduced red light desaturation in the right eye and reduced vision in the center of bilateral visual fields.On fundoscopy, no signs of optic disc edema or pallor.Motor strength and sensation were intact.MRI brain and orbits demonstrated enhancement of the right optic sheath compatible with right OPN.Labs were notable for erythrocyte sedimentation rate (ESR) of 30 and C-reactive protein (CRP) of 0.31.Rheumatological workup included ANA, dsDNA, anti-Smith, ANCA, rheumatoid factor, myelin-oligodendrocyte glycoprotein, aquaporin-4, anti-SS-A, anti-SS-B, C3/C4 and ACE were either negative or within normal limits.Infectious workup included negative Lyme antibodies, HSV PCR, rapid plasma reagin, and QuantiFERON.Cerebrospinal fluid resulted glucose 79, protein 22, negative cytology and no oligoclonal bands.The patient completed five days of intravenous methylprednisolone followed by an eight-week oral steroid taper. ConclusionsMost cases of OPN are idiopathic or secondary to an underlying autoimmune disease or infection.Our case highlights a case of influenza induced OPN, suggesting an underlying reactive orbital inflammatory response.While influenza induced ON is common, influenza induced OPN is rare.