Man experiences recurrent bilateral optic neuritis

A 71-year-old man was referred by his usual ophthalmologist to the neuro-ophthalmology clinic at Tufts Medical Center for bilateral decreased vision associated with bilateral optic disc edema.
His medical history was notable for trigeminal neuralgia diagnosed after a negative temporal artery biopsy and currently treated with low-dose steroids. He also had a history of Lyme disease complicated by a cardiac arrhythmia, hypertension and hyperlipidemia. His ocular history included cataracts and presbyopia.
About 1 month before his vision loss, he had an upper respiratory tract infection that

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