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.