The use of intravenous pulse-steroid therapy in optic neuropathy from nasopharyngeal carcinoma

Abstract

Although nasopharyngeal carcinoma (NPC) is commonly seen in patients from Asia, optic neuropathy is a rare initial presenting symptom of this disease. This is an interventional case report discussing the clinical response of NPC-related optic neuropathy to pulse-steroid therapy. 
We discuss two patients who initially presented with signs of optic neuropathy. On imaging, a skull-base tumor was noted infiltrating the area of the affected optic nerve. An excision biopsy of the tumor revealed nasopharyngeal carcinoma. Both patients were pulsed with intravenous (IV) methlyprednisolone one gm/day for three days, followed by oral steroids (one mg/kg/BW) with gradual tapering. After two weeks, both showed visual improvement and chemo- and radiation therapy commenced at this time. 
In these two cases, pulse-steroid therapy did not hinder the chemo- and radiation therapy for nasopharyngeal carcinoma. Steroid therapy brought immediate visual recovery and gradual oral tapering could assist in optimizing visual outcomes for patients with compressive optic neuropathy from nasopharyngeal carcinoma.