Retrobulbar optic neuritis in association with HBV
Published in the Journal of Medical Case Reports, the authors present a case of a 46-year-old man with a past medical history of untreated chronic hepatitis B virus, diagnosed 5 years ago, who presented on two occasions with the chief compliant of blurry vision.

He was diagnosed with optic neuritis associated with acute on chronic hepatitis B virus infection, where the recurrent visual impairment was the main presenting symptom.

Because hepatitis constituted a relative contraindication for steroid therapy, our patient was solely treated with antiviral medication. Antiviral therapy resulted in complete resolution of his symptoms and improvement in his liver function.

Learning points
• Retrobulbar optic neuritis in association with HBV is rarely the only manifestation of chronic hepatitis B flare. The recommended standard of care involves the use of systemic steroids.

• However, given the recurrence of HBV flare, the risk of worsening hepatitis with a high-dose steroid is a reality. Consequently, our options were limited to antiviral therapy alone.

• This patient successfully achieved a complete resolution of symptoms with an improvement of his liver function after treatment with entecavir alone.

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