Sempere et al. Journal of Medical Case Reports 2011, 5:319 http://www.jmedicalcasereports.com/content/5/1/319 showed marked delay of the P100 component from both eyes and attenuation of P100 wave amplitude. Labora- tory investigation results revealed a normal blood count, and normal levels of liver enzymes, serum creatinine, angiotensin-converting enzyme, erythrocyte sedimenta- tion rate, vitamin B12, folate and thyroid hormones. Serum levels of immunoglobulin were 1590 mg/100 mL, < 6 mg/100 mL, and 380 mg/100 mL for IgG, IgA and IgM, respectively. Serum serologies for Lyme, syphilis, Brucella, viral hepatitis, Bartonella henselae and HIV were negative. Test results for anti-nuclear antibodies, rheumatoid factor, anti-nuclear cytoplasmic antibodies, anti-phospholipid antibodies, anti-CV2, and anti-neuro- myelitis optica (NMO) antibodies were also all negative. Fluorescein angiography showed no signs of retinal vas- culitis. In addition, a chest and abdominal computed tomography (CT) scan and a whole-body positron emis- sion tomography (PET) scan were unrevealing. A genetic study for Leber’s hereditary optic neuropathy was also negative. Cerebral spinal fluid (CSF) analysis revealed normal protein and glucose levels and a white cell count of 2 cells/mm3 for all lymphocytes. No oligoclonal bands were present. No malignant cells were observed, and a microbiological investigation including CSF bacterial, fungal and mycobacterial cultures was negative. In addi- tion, CSF PCR tests for enteroviruses, Herpes simplex virus, varicella zoster, Epstein-Barr, and cytomegalovirus were all negative. Our patient was diagnosed with bilateral optic neuri- tis and treated with intravenous methylprednisolone (1000 mg/day for five days) and a tapering course of oral prednisone. Two weeks later, his visual acuity was one in the right eye and 0.6 in the left eye. Our patient remained asymptomatic at 12-month follow-up, when visual acuity was one in the right eye and 0.8 in the left eye. Discussion Bilateral simultaneous optic neuritis is uncommon in adults [3]. In our patient, there was no evidence of a toxic, infectious or neoplastic disorder. Sarcoidosis seemed unlikely in view of the negative chest CT and PET scan results as well as the normal serum angioten- sin-converting enzyme levels. Neuromyelitis optica also seemed improbable considering the normal spinal cord MRI, negative NMO antibodies and absence of recur- rent episodes during the follow-up period [4]. Although CVID has been linked to uveitis [5] and retinal vasculitis [6], it has to date not been linked to optic neuritis. Patients with CVID are predisposed to several autoim- mune disorders, and bilateral optic neuritis should be added to the list. If a patient with CVID experiences loss of vision, the possibility of bilateral optic neuritis Page 2 of 2 should be considered because rapid initiation of high- dose corticosteroids may improve visual recovery. Conclusions This case report describes an unreported complication of common variable immunodeficiency: bilateral optic neuritis, linked to the autoimmune manifestation of the disease. If a patient with common variable immunodefi- ciency experiences loss of vision, the possibility of bilat- eral optic neuritis should be considered. Consent Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Acknowledgements The study was supported by a grant from Fundación para el desarrollo de la investigación de la Neurología de la Comunidad Valenciana. Author details 1Neurology Department, Hospital General Universitario de Alicante, Alicante, Spain. 2Hematology Service, Hospital Marina Baixa, Villajoyosa, Spain. Authors’ contributions APS and MLT conceived the study and drafted the manuscript, SPD and AGP helped to draft the manuscript. All authors have read and approved the final draft. Competing interests The authors declare that they have no competing interests. Received: 14 August 2010 Accepted: 19 July 2011 Published: 19 July 2011 References 1. Bussone G, Mouthon L: Autoimmune manifestations in primary immune deficiencies. Autoimmun Rev 2009, 8:332-336. 2. Kumar N, Hagan JB, Abraham RS, Aksamit AJ: Common variable immunodeficiency-associated myelitis: report of treatment with infliximab. J Neurol 2008, 255:1821-1824. 3. De la Cruz J, Kupersmith MJ: Clinical profile of simultaneous bilateral optic neuritis in adults. Br J Ophthalmol 2006, 90:551-554. 4. Sellner J, Boggild M, Clanet M, Hintzen RQ, Illes Z, Montalban X, Du Pasquier RA, Polman CH, Sorensen PS, Hemmer B: EFNS guidelines on diagnosis and management of neuromyelitis optica. Eur J Neurol 2010, 17:1019-1032. 5. Gray R, Vodden J, Gompels M: Uveitis in a patient with common variable immunodeficiency. Eye 2003, 17:99-101. 6. van Meurs JC, Lightman S, de Waard PW, Baarsma GS, van Suijlekom- Smit LW, van de Merwe JP, de Groot R: Retinal vasculitis occurring with common variable immunodeficiency syndrome. Am J Ophthalmol 2000, 129:269-270. doi:10.1186/1752-1947-5-319 Cite this article as: Sempere et al.: Bilateral optic neuritis in a 26-year-old man with common variable immunodeficiency: a case report. Journal of Medical Case Reports 2011 5:319.