Correspondence Address:
Dr. Almurtada Ali Razok
Hamad General Hospital, P.O Box 3050, Doha
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A 47-year-old male with a background of obesity, diabetes mellitus Type II, and dyslipidemia presented with a 3-day history of right-sided loss of vision. It was sudden in onset, painless with no associated floaters or light flashes. There was no headache, photophobia, nausea, vomiting, seizures, and sensory or motor abnormalities. The patient reported a similar episode on the left side 1 year ago, which persisted and caused chronic decrease in visual acuity. Review of other systems was negative for weight loss, fever, scalp tenderness, jaw claudication, and arthralgia. A detailed neurologic physical examination did not reveal any sensory or motor abnormalities. Left-sided relative afferent pupillary defect with bilateral decrease in color vision was appreciated. Findings of fundoscopic examination are shown in [Figure 1]a (left eye) and [Figure 1]b (right eye). Magnetic resonance imaging (MRI) of the orbit, head, and spine with contrast revealed evidence of chronic optic neuritis on the left and acute optic neuritis on the right. There was no evidence of demyelination or diffusion restriction. HBA1C was 8.6%, total cholesterol 6 mmol/L, LDL 3.54 mmol/L, erythrocyte sedimentation rate (ESR) 14 mm/h, and C-reactive protein (CRP) 0.6 mg/L. Complete blood count and comprehensive metabolic panel were essentially normal. The patient's home medications included metformin 1000 mg twice daily and atorvastatin 20 mg once daily at bedtime.{Figure 1}

 Question: What Is the Diagnosis That Best Fits With the Clinical Picture?

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