Abstract
Objective: We describe a patient diagnosed with acute neuroborreliosis presenting with anterior optic neuritis (papillitis) in a non-endemic region. Case Presentation: A 43-year-old previously healthy right handed man admitted due to an insidious onset of severe headache and spells of ascending paresthesias from his right foot into his right arm and face followed by speech arrest and clumsiness of his right hand. His neurologic exam was significant for somnolence, nuchal rigidity and Kernig and Brudzinski signs were present. MRI of the brain with gadolinium showed diffuse hyperintense signal involving the supra and infratentorial cortical sulci, with associated faint diffuse leptomeningeal enhancement, consistent most likely with diffuse leptomeningoencephalitis. EEG: normal. CSF VDRL was negative. Dilated fundus exam revealed mild optic nerve edema more significant to the left than to the right eye, confirmed and measured by spectral domain OCT (Optical Coherence Tomography). There was an evidence of posterior uveitis with an early vitreous hemorrhage superficial to the left optic nerve. Lyme disease serum antibody (IgM) Immunoblotting was positive in 2 bands confirming the diagnosis of neuroborreliosis. Conclusion: Optic nerve involvement in Lyme disease is an uncommon complication that should be confirmed by specific diagnostic criteria to establish its causal relation.
Highlights
Lyme disease (LD) is the most common arthropod-borne infectious disease in temperate regions of the northern hemisphere in Europe and is caused by Borrelia burgdorferi, a spirochete transmitted by Ixodes ticks [1]
We describe a patient diagnosed with acute neuroborreliosis presenting with anterior optic neuritis in a non-endemic region
Lyme disease serum antibody (IgM) Immunoblotting was positive in 2 bands (23 kD and 39 kD bands) confirming the diagnosis of acute neuroborreliosis
Summary
Lyme disease (LD) is the most common arthropod-borne infectious disease in temperate regions of the northern hemisphere in Europe and is caused by Borrelia burgdorferi, a spirochete transmitted by Ixodes ticks [1]. A host of ophthalmological manifestations have been described, ranging from chronic follicular conjunctivitis, keratitis [4] [5] optic neuritis to anterior, intermediate or posterior uveitis, scleritis and reversible horner’s syndrome. These ocular manifestations are more frequently seen in late stages of the disease (2nd and 3rd stage). The first case of ocular lymeborreliosis was reported on 1985 where the patient went blind from severe panophthalmitis and Borrelia burgdorferi spirochetes were found in his vitreous. We describe a patient diagnosed with acute neuroborreliosis presenting with anterior optic neuritis (papillitis) in a non-endemic region
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