Case History/Examination:
We present a 27 years old medically free gentleman who was admitted
because of 4 days history of gradually worsening vision in both eyes
reaching to the point that he could not see his mobile phone screen. He
gave no further complaints, no limb weakness, no speech or swallowing
deficits, and he had good control over his urine and defecation. He did
not mention any numbness and never experienced this before. His work up
in the hospital revealed bilateral optic neuritis and his brain MRI
showed demyelinating lesions suggestive of multiple sclerosis. He was
commenced on pulse steroids for 5 days without improvement and the
decision was to start him on plasma exchange where he received 7
sessions through a right jugular venous line. He finished 7 sessions of
plasma exchange with only slight improvement in his vision. On the day
of discharge, his jugular venous line was removed by his assigned
physician in sitting position after which , he immediately developed
difficulty breathing and became hypoxic and his O2 saturation dropped to
70% , he was immediately commenced on high flow nasal canula, intensive
care team attended the case on the scene.