Successful Long-Term Treatment of Pediatric Relapsing Idiopathic Optic Neuritis with Mycophenolate Mofetil
<b>Background:</b> Pediatric optic neuritis (ON) is a rare but severe condition characterized by acute visual impairment, with 3–5% of relapsing cases lacking identifiable markers for associated conditions, such as neuromyelitis optica spectrum disorder (NMOSD) or multiple sclerosis (MS)...
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2025-03-01
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| author | Shuhei Fujino Keiji Akamine Eiichiro Noda Sahoko Miyama |
| author_facet | Shuhei Fujino Keiji Akamine Eiichiro Noda Sahoko Miyama |
| author_sort | Shuhei Fujino |
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| description | <b>Background:</b> Pediatric optic neuritis (ON) is a rare but severe condition characterized by acute visual impairment, with 3–5% of relapsing cases lacking identifiable markers for associated conditions, such as neuromyelitis optica spectrum disorder (NMOSD) or multiple sclerosis (MS); these cases are thus classified as relapsing idiopathic optic neuritis (RION). Corticosteroids are typically used for acute management; however, their prolonged use in children poses significant risks, including central obesity, hypertension, and growth impairment, underscoring the need for nonsteroidal, long-term treatment options. Current strategies for preventing recurrence in pediatric RION are limited due to a lack of data on immunosuppressive efficacy and safety. Given its rarity and the challenges of long-term immunosuppression in children, identifying optimal therapeutic approaches remains critical. <b>Case Presentation:</b> We report a case of a six-year-old girl with RION, who was initially treated with intravenous methylprednisolone (IVMP) and prednisolone (PSL) tapering, and who experienced recurrence eight months post-treatment. Additional corticosteroids and intravenous immunoglobulin (IVIg) were administered during relapse, but, due to adverse effects, treatment was transitioned to mycophenolate mofetil (MMF), enabling early PSL tapering. <b>Conclusions:</b> With MMF, the patient maintained stable vision and achieved a five-year recurrence-free period without notable side effects. In conclusion, this case suggests MMF’s efficacy as a long-term management option for pediatric RION, potentially reducing corticosteroid-related risks. |
| format | Article |
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| institution | Kabale University |
| issn | 2035-8377 |
| language | English |
| publishDate | 2025-03-01 |
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| spelling | doaj-art-8b335a9bfa26456680f6363d092bf3e42025-08-20T03:43:29ZengMDPI AGNeurology International2035-83772025-03-011734410.3390/neurolint17030044Successful Long-Term Treatment of Pediatric Relapsing Idiopathic Optic Neuritis with Mycophenolate MofetilShuhei Fujino0Keiji Akamine1Eiichiro Noda2Sahoko Miyama3Department of Neurology, Tokyo Metropolitan Children’s Medical Center, Tokyo 183-8561, JapanDepartment of Nephrology, Tokyo Metropolitan Children’s Medical Center, Tokyo 183-8561, JapanDepartment of Ophthalmology, Tokyo Metropolitan Children’s Medical Center, Tokyo 183-8561, JapanDepartment of Neurology, Tokyo Metropolitan Children’s Medical Center, Tokyo 183-8561, Japan<b>Background:</b> Pediatric optic neuritis (ON) is a rare but severe condition characterized by acute visual impairment, with 3–5% of relapsing cases lacking identifiable markers for associated conditions, such as neuromyelitis optica spectrum disorder (NMOSD) or multiple sclerosis (MS); these cases are thus classified as relapsing idiopathic optic neuritis (RION). Corticosteroids are typically used for acute management; however, their prolonged use in children poses significant risks, including central obesity, hypertension, and growth impairment, underscoring the need for nonsteroidal, long-term treatment options. Current strategies for preventing recurrence in pediatric RION are limited due to a lack of data on immunosuppressive efficacy and safety. Given its rarity and the challenges of long-term immunosuppression in children, identifying optimal therapeutic approaches remains critical. <b>Case Presentation:</b> We report a case of a six-year-old girl with RION, who was initially treated with intravenous methylprednisolone (IVMP) and prednisolone (PSL) tapering, and who experienced recurrence eight months post-treatment. Additional corticosteroids and intravenous immunoglobulin (IVIg) were administered during relapse, but, due to adverse effects, treatment was transitioned to mycophenolate mofetil (MMF), enabling early PSL tapering. <b>Conclusions:</b> With MMF, the patient maintained stable vision and achieved a five-year recurrence-free period without notable side effects. In conclusion, this case suggests MMF’s efficacy as a long-term management option for pediatric RION, potentially reducing corticosteroid-related risks.https://www.mdpi.com/2035-8377/17/3/44pediatric optic neuritisrelapsing idiopathic optic neuritiscorticosteroidsmycophenolate mofetilneuromyelitis optica spectrum disorderimmunosuppressives |
| spellingShingle | Shuhei Fujino Keiji Akamine Eiichiro Noda Sahoko Miyama Successful Long-Term Treatment of Pediatric Relapsing Idiopathic Optic Neuritis with Mycophenolate Mofetil Neurology International pediatric optic neuritis relapsing idiopathic optic neuritis corticosteroids mycophenolate mofetil neuromyelitis optica spectrum disorder immunosuppressives |
| title | Successful Long-Term Treatment of Pediatric Relapsing Idiopathic Optic Neuritis with Mycophenolate Mofetil |
| title_full | Successful Long-Term Treatment of Pediatric Relapsing Idiopathic Optic Neuritis with Mycophenolate Mofetil |
| title_fullStr | Successful Long-Term Treatment of Pediatric Relapsing Idiopathic Optic Neuritis with Mycophenolate Mofetil |
| title_full_unstemmed | Successful Long-Term Treatment of Pediatric Relapsing Idiopathic Optic Neuritis with Mycophenolate Mofetil |
| title_short | Successful Long-Term Treatment of Pediatric Relapsing Idiopathic Optic Neuritis with Mycophenolate Mofetil |
| title_sort | successful long term treatment of pediatric relapsing idiopathic optic neuritis with mycophenolate mofetil |
| topic | pediatric optic neuritis relapsing idiopathic optic neuritis corticosteroids mycophenolate mofetil neuromyelitis optica spectrum disorder immunosuppressives |
| url | https://www.mdpi.com/2035-8377/17/3/44 |
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