Bilaterale akute konfluierende Chorioiditis disseminata bei Borrelia burgdorferi-Infektion

Abstract

Two patients with bilateral extensive confluent choroidal lesions, exudative retinal detachments, positive lyme serology and a typical history are documented: A 32-year-old woman presented 14 days after a "flu-like" illness with bilateral acute extensive choroidal lesions and exudative retinal detachments (OD from 5 to 8:30 o'clock, OS from 5 to 8 o'clock, both including the macula) accompanied by a mild lymphocytic meningitis. The laboratory work-up revealed increased serum and CSF titers of antibodies against Borrelia burgdorferi (Lyme immunofluorescent test (IFT) and Lyme-IgM IFT) which declined after a 14-day treatment with doxycycline (200 mg/d), CSF titers non-detectable (serum IgG: from 1:640 to 1:320, serum IgM: from 1:40 to 1:20). A distinct improvement with visual acuity increasing from OD 0.2/OS 0.3 p to OD/OS 0.8 p was observed after seven days of treatment. A 40-year-old man with a 14-day history of tick-bite developed the same, though more severe ocular findings and a lymphocytic meningitis. The serological work-up revealed increased antibody titers against Borrelia burgdorferi (ELISA); the IgM titer was normal. After a 10-day treatment with penicillin, antibody titers against the spirochete decreased slightly and the patient's neurologic and ophthalmologic status improved dramatically. Five weeks after admission visual acuity was OD/OS 0.5 (compared to OD/OS 0.1) and has remained at 0.8 p (OD/OS) since the ninth week after onset. The clinical course of the disease and the decreasing lyme serology strongly suggest an infection with Borrelia burgdorferi. The authors propose thorough laboratory work-ups including tests for Lyme disease in selected patients with diffuse choroidal lesions.

Prevalence and causes of clinically detectable uveitic serous retinal detachment

“…Six of the 15 patients (40.0%) with idiopathic or indeterminant disease had bilateral SRD. Of Behcet's disease 8,9 Cat scatch disease *10,11 Herpetic necrotizing retinitis (HSV, HZV, CMV) 12,13 Inflammatory bowel disease 14,15 Lyme disease 16,17 Posterior scleritis 18,19 Sympathetic ophthalmia Diffuse unilateral subacute neuroretinitis (DUSN) 35,36 H1N1 influenza vaccination 37 Hepatitis, chronic **2,38 HLA-B27-associated uveitis 39,40 Intraocular lymphoma ***41,42 Juvenile idiopathic arthritis 43,44 Paracoccioidomycosis 45 Pars planitis (peripheral) 46,47 Pneumocystis jiroveci infection 48 Sarcoidosis 49,50 Serpiginous choroiditis 51,52 Subacute sclerosing panencephalitis (SSPE) 53 Toxocariasis 54 Toxoplasmosis 55,56 Typhoid fever 57 The demographics of the VKH and idiopathic or indeterminant disease groups are summarized in Table 3.…”