Bilateral blindness from optic chiasm metastasis as the initial presentation of stage 4 neuroblastoma: A case report

Rationale: Neuroblastoma is the most common extracranial solid tumor in early childhood and may present with nonspecific symptoms that delay diagnosis, particularly in resource-limited settings. Intracranial involvement affecting the optic pathway is exceptionally rare. This report describes an unusual presentation of neuroblastoma leading to irreversible bilateral blindness. Patient concerns: A 29-month-old male with albinism presented with fever, abdominal pain, and pallor and was initially treated for a presumed urinary tract infection. Within days, he developed awakening headache followed by sudden bilateral blindness. Diagnoses: Imaging studies, including ultrasound, computed tomography, and magnetic resonance imaging, revealed a large right suprarenal mass with widespread metastases involving the optic chiasm and cranial bones. Histopathological examination confirmed stage 4 neuroblastoma. Interventions: The patient underwent surgical debulking followed by chemotherapy according to the St. Jude high-risk protocol. Outcomes: Partial regression of metastatic lesions was achieved; however, visual loss remained permanent. Lessons: Neuroblastoma may present with atypical neurological manifestations, including optic chiasm metastasis leading to blindness. Early abdominal imaging in pediatric patients with unexplained systemic or abdominal symptoms is essential to prevent delayed diagnosis and irreversible complications.