A case report of hepatitis B related optic neuritis treated with plasma exchange

INTRODUCTION: There are few studies focusing on Binocular hepatitis B related optic neuritis (HB-ON) and associated therapies are still limited. We present a case of HB-ON which has been cured with therapeutic plasma exchange (TPE). PATIENT CONCERNS: The patient was diagnosed as acute hepatitis B in hepatology and got a rapid loss of binocular visual acuity (2/100 in the right eye and no light perception in the left eye) after the onset. DIAGNOSIS: Hepatitis B related optic neuritis. INTERVENTIONS: Methylprednisolone and therapeutic plasma exchange. OUTCOMES: The treatment of high dose methylprednisolone was not curative. After 5 TPE sessions, the patient's best corrected visual acuity (BCVA) returned to 20/20 in the right eye and finger counting (FC)/40 cm in the left eye. One month later, the visual acuity increased to 5/100 in the left eye. CONCLUSION: This is the first case in which we used TPE to cure HB-ON. Also, it can demonstrate the relationship between HB-ON and immunopathogenesis. The case may provide an effective method for the treatment of hormone invalid and disabled ON in clinical practice.