A mystery case of proptosis, optic neuropathy, and peripheral neuropathy.

Six months later, she noticed proptosis of the right eye and her diplopia persisted. Our examination showed acuity of 20/20 OU and a left relative afferent pupillary defect. She had 3 mm of right proptosis, -3 adduction deficit in her right eye and -2 abduction deficit in her left eye with -1 elevation deficit bilaterally. There was no nystagmus. Saccades were normal. She had one Lisch nodule and one café au lait spot less than 2 cm. The optic nerves appeared pale OS > OD. She had weakness of dorsiflexion, absent reflexes, absent vibration sense, and high arches.