HLA-B27-Associated Papillitis and Vasculitis Masquerading as Idiopathic Intracranial Hypertension (IIH)

A 50-year-old woman experienced imerminem "pinpoint flashes of light moving away from me" in born eyes for two months. Her past medical history included moderate obesity, intermittent headache and fibromylagia-induced polyarticular arthritis and back pain. On examination, her visual acuity was 16/15 in both eyes. Her visual fields showed non-specific defects. Her color vision was normal, and chere was no afferent pupillary defect. Her anterior segment exam was unremarkable. Her fundus exam was significant for bilateral disc edema, optic nerve head drusen and the presence of a left peripapillary hanorrhage. MRI of the brain and orbits was unremarkable. An ophthalmic ultrasound confirmed optic head drusen in both eyes. Lumbar puncture revealed an opening pressure of 25 cm H2O. Cerebral spinal fluid test was normal. She was diagnosed with "atypical" IIH and started on acetazolamide.