Coxsackie B5 papillitis.

radiculopathy caused by lipoma, patient with multiple congenital skeletal anomalies and intrathoracic lipomas. Sir: We describe the clinical and electro-physiological findings in a patient with papillitis associated with coxsackie B5 viral infection. Reports of proven coxsackie B papillitis are rare and in this case the electrodiagnostic studies provide interesting evidence ofthe site of the visual dysfunction. A 32 year old white male developed symptoms of severe frontal headaches, night sweats, joint aches, photophobia and neck stiffness which resolved spontaneously. Two and a half weeks later the headaches and fever returned accompanied by pain on ocular movement. These symptoms persisted for a week and one week later he presented with progressive central blurring of vision in his left eye. There was nothing of note in his past medical or family history and there was no history of drug usage other than paracetamol for the headache. On examination visual acuities were 6/5 right, and hand movements left. The left visual field showed a large central scotoma, the right an enlarged blind spot. A left relative afferent pupillary defect was present. There was flare with cells in his left anterior chamber and cells in the anterior vitreous of both eyes, but more in the left eye than the right. Both optic discs were considerably swollen with peripapillary nerve fibre layer haemorrhages; a macular star was present in the left eye (fig a, b). Ocular movements were full but there was discomfort on lateral gaze of each eye. Neurological examination revealed no focal abnormality and systemic examination was unremarkable. He was apyrexial. Investigations showed normal urea and Letters electrolytes, normal liver function and plasma proteins, apart from an increase in a 2 globulin; TPHA/VDRL were negative, ESR 14 mm/h, Hb 14-9 g/l, WBC 123, platelets 223. A lumbar puncture showed a CSF pressure of 160 mm, 18 lymphocytes, protein 0 45 g/l (no increase in globulin) and glucose of 3-8 mmol/l (blood glucose 5-4 mmol/l). Serum angiotensin converting enzyme was normal as was a complement profile. Immune complexes were slightly raised by PEG precipitation assay at 6-0 mg/ IgG/dl (normal 4 9). Chest radiograph and CT of the brain were normal. Fluorescein angiography confirmed bilateral swollen discs with adjacent peripapillary serous retinal detachment. EEG was normal. Electrodiagnostic testing comprised EOG, ERG, pattern ERG (PERG) and both flash and pattern VEPs (FVEP, PVEP). PVEP and FVEP from the right eye fell within the normal range …