Metastatic Melanoma of the Optic Nerve Sheath

Clinical challenge - scratching the surface of the sheath

A 63-year-old white man with hypertension, hyperlipidemia, adrenal insufficiency, and history of metastatic spindle cell melanoma previously treated with ipilimumab, presented with unilateral papillitis in the left eye. The disc edema evolved to neuroretinitis with additional MRI findings of perineuritis. Broad laboratory evaluation confirmed active B. henselae infection, and he confirmed exposure to a newly adopted kitten. His vision improved following a course of antibiotics and oral steroids with resolution of clinical findings. To the best of our knowledge, this is the first reported case of cat-scratch neuroretinitis with MRI findings of optic nerve and optic nerve sheath enhancement.

Metastatic Squamous Cell Lung Carcinoma to the Optic Nerve Sheath Mimicking Retrobulbar Optic Neuritis

Lung carcinoma is the second most common malignancy in both men and women, and may metastasize to the orbit relatively early in the disease course. Metastasis to the optic nerve or its sheath is an exceedingly rare occurrence, and diagnosis may be complicated by nonspecific clinical and radiographic features. The authors present a case of squamous cell lung cancer metastatic to the optic nerve sheath, initially diagnosed as optic neuritis based on its equivocal clinical and radiographic features. This is the first histopathologically confirmed case of squamous cell lung cancer metastatic to the optic nerve sheath in the literature.