Lyme disease atypically presenting with a singular symptom: Unilateral chorioretinitis

Havuz, Erol; Havuz, Seda Güdül

doi:10.1177/1120672120962055

Cited by 7 publications

(6 citation statements)

References 6 publications

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“…7 a-c Fluorescein angiography of the left eye 4 months after initial presentation showing early hypofluorescence of the lesion inferior to the fovea followed by late staining with possible central leakage occurs in acute syphilitic posterior placoid choroiditis [12]. Recently, a case from Turkey was published showing unilateral chorioretinitis, similar in presentation to our patient, with western blot verified Lyme disease, who had significant improvement following treatment with doxycycline and 10 days of oral prednisone, without recurrence [15]. Of note, a literature review has not returned a specific association between pregnancy and activation or contraction of Lyme disease [16,17].…”

Section: Discussionsupporting

confidence: 64%

Recurrent bilateral chorioretinitis with positive Lyme serology: a case report

Issa

DeSouza

2021

J Med Case Reports

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Background It has been disputed whether Lyme is a true causative agent in posterior uveitis or an incidental finding. Case presentation This report presents a case of a 33-year-old Caucasian female with a remote history of Lyme disease who presented with blurry vision in the right eye. Exam and imaging revealed a right active chorioretinitis and positive Lyme serology. The patient was systemically treated with prednisone and antibiotics. Symptoms initially improved, but she later developed a localized choriocapillaritis in the left eye. Steroids and antibiotics were restarted many times with fluctuating course of the disease. The patient was then started on chronic steroid-sparing immunosuppression, which has controlled the condition without recurrence. Conclusions The current report presents a unique case of recurrent bilateral chorioretinitis with positive Lyme serology and raises the question of the existence of true Lyme-associated uveitis.

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Section: Discussionsupporting

confidence: 64%

Recurrent bilateral chorioretinitis with positive Lyme serology: a case report

Issa

DeSouza

2021

J Med Case Reports

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“…17,18 Whereas most of the patients with ocular Lyme disease have shown a bilateral involvement, our case and few others have reported an unilateral ocular involvement. 19 In our case, we observed the presence of unilateral uveitis with marked vitreitis and patchy, yellowish lesions and retinal vasculitis. In our case, it was important to consider ocular Toxoplasmosis in the differential diagnosis; in fact, ocular toxoplasmosis often presents as a focal necrotizing retinitis or a chorioretinitis associated with variably pigmented chorioretinal lesions, with the presence of severe vitreitis producing the classic 'headlight in the fog' sign.…”

Section: Discussionsupporting

confidence: 48%

“…Whereas most of the patients with ocular Lyme disease have shown a bilateral involvement, our case and few others have reported an unilateral ocular involvement. 19…”

Section: Discussionmentioning

confidence: 99%

Multimodal imaging for the management of Lyme-associated uveitis: A case report from an Italian tertiary center

Desideri

Rosa

Forte

et al. 2023

European Journal of Ophthalmology

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Introduction Lyme borreliosis may present with different systemic manifestations and also the ocular involvement may be difficult to diagnose because of its multifaceted presentation. Considering the growing incidence of Lyme disease in European countries, ophthalmologist should be trained to distinguish ocular borreliosis. Case Report Several clinical presentations have been previously described, including uveitis, unilateral or bilateral chorioretinitis, keratitis, episcleritis, papillitis and ischemic optic neuropathy, retinal vasculitis and acute posterior multifocal placoid pigment epitheliopathy (APMPPE); however our case report showed a rare presentation with the presence of unilateral uveitis with vitreitis and multiple, patchy, yellowish lesions, in association with retinal vasculitis. This clinical picture was to be considered in differential diagnosis with ocular Toxoplasmosis. Conclusions The appropriate management of this patient was made possible by the combination of multimodal imaging and appropriate laboratory tests, representing the optimal process in the diagnostic and therapeutic pathway in high-risk patients for ocular Lyme disease.

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“… 1 These patients often have unrecognized and untreated Lyme disease at the time of evaluation; they present with visual acuity loss or blurred vision, and antibiotic treatment often resolves the visual findings. 35 – 44 In one study, a high proportion of Lyme disease cases referred for evaluation had convergence insufficiency (53%), but the stage of Lyme disease was not reported and visual acuity data were not presented. 45 In case series where ocular disease did not resolve after treatment, visual acuity loss also persisted.…”

Section: Discussionmentioning

confidence: 99%

Contrast Sensitivity Loss in Patients With Posttreatment Lyme Disease

Rebman

Yang

Mihm

et al. 2021

Trans. Vis. Sci. Tech.

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Purpose Posttreatment Lyme disease (PTLD) is marked by neurologic symptoms, cognitive impairment, and significant symptom burden, including fatigue and ocular complaints. The purpose of this study was to determine whether contrast sensitivity (CS) is altered in patients with PTLD compared with healthy controls and, second, whether CS is associated with cognitive and/or neurologic deficits. Methods CS was measured using a Pelli–Robson chart with forced-choice procedures, and the total number of letters read was recorded for each eye. CS impairment was defined for age <60 years as logCS of 1.80 (36 letters or fewer) and for those age ≥60 years as logCS of 1.65 (33 letters or fewer). Participants self-administered a questionnaire to assess presence of ocular symptoms and underwent a neurologic exam and battery of neurocognitive tests. Results CS impairment was associated with an increased odds of being in the PTLD group that was 2.6 times as high as those without CS impairment (odds ratio, 2.6; 95% confidence interval, 1.3–5.2). Neither cases nor controls had significant distance acuity impairment. CS impairment was not associated with any of the ocular complaints in cases but was borderline associated with neurologic abnormalities and cognitive impairment. Conclusions CS impairment in patients with PTLD is linked to signs of cognitive and neurologic impairment and may be a marker of illness severity. Translational Relevance Further investigation into the value of testing CS impairment in PTLD cases is warranted, especially if it is an indicator of cognitive or neurologic manifestations.

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Lyme disease atypically presenting with a singular symptom: Unilateral chorioretinitis

Cited by 7 publications

References 6 publications

Recurrent bilateral chorioretinitis with positive Lyme serology: a case report

Recurrent bilateral chorioretinitis with positive Lyme serology: a case report

Multimodal imaging for the management of Lyme-associated uveitis: A case report from an Italian tertiary center

Contrast Sensitivity Loss in Patients With Posttreatment Lyme Disease

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