Sudden Bilateral Vision Loss in A Young Patient with Systemic Autoimmune Disease and A Normal Brain MRI, which Responded to Steroid Treatment.

Background: Sudden bilateral visual loss is a rare but alarming manifestation, particularly in young patients with systemic autoimmune disorders. Case report: We describe the case of a 26-year-old woman with systemic lupus erythematosus, juvenile idiopathic arthritis, and Sjögren's syndrome, who presented with sudden bilateral vision loss following headache, vomiting, and diarrhoea. Ophthalmologic evaluation excluded hydroxychloroquine toxicity. Brain magnetic resonance imaging revealed no acute ischemic or demyelinating lesions. High-dose intravenous methylprednisolone was initiated, leading to near-complete recovery of vision. Conclusion: Autoimmune optic neuropathy should be considered in young patients with sudden bilateral vision loss, even in the absence of neuroimaging abnormalities. Prompt recognition and empirical corticosteroid therapy may prevent irreversible disability. LEARNING POINTS: Sudden bilateral vision loss in young patients with autoimmune diseases should raise suspicion for immune-mediated optic neuropathy.Normal magnetic resonance imaging and fundoscopy findings do not exclude serious inflammatory pathology.Early empirical corticosteroid therapy can be vision-saving.