Optic Neuritis in Acute Neuroborreliosis (Lyme Disease) in the U.S.-Mexican Border: Case Report

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.

Uveitis associated with Lyme disease in Mexico

“…On the other hand, PCR is only performed in the synovial fluid of patients with arthritis and a suspected diagnosis of the disease, and there are isolated reports of its diagnostic utility in ocular tissues, such as conjunctiva, aqueous or vitreous humor 31,32 . Thus, the diagnosis of uveitis secondary to Lyme borreliosis is based on the history of exposure to tick bites or hazardous environments; on a positive differential serological analysis during the disseminated and persistent stages; on the resistance to steroid treatment, and on the favorable response to antibiotic therapy, as well as on the exclusion of other potential diagnoses 33,34 . In this case, the patient had an epidemiological history considered as a risk for developing Lyme borreliosis, did not show improvement with steroid treatment and the serology for other causes of uveitis was negative.…”

Characteristics of Lyme optic neuritis: a case report of Lyme associated bilateral optic neuritis and systematic review of the literature

“…Left RAPD 4. Decreased color vision Unremarkable MRI : typical lesion characteristics of MS Methylprednisolone Medaxone Cefprozil Normalized Qureshi, et al (2016) [ 23 ] 43/M Does not recall unreported 1. Headache 2.…”

Uveítis secundaria a Borreliosis de Lyme en México

“…ordinaria en líquido sinovial de pacientes con artritis sospechosos de padecer la enfermedad, y existen reportes aislados de su utilidad diagnóstica en tejidos oculares, como conjuntiva, humor acuoso o vítreo 31,32 . Entonces, el diagnóstico de la uveítis secundaria a borreliosis de Lyme está basado en los antecedentes de exposición a mordedura por garrapata o ambientes de riesgo; en un análisis serológico diferenciado positivo durante las etapas diseminada y persistente; en la resistencia al tratamiento con esteroides, y en la respuesta favorable a la antibióticoterapia, así como en la exclusión de otros diagnósticos probables 33,34 . En este caso, la paciente tenía antecedentes epidemiológicos de riesgo para desarrollar la borreliosis de Lyme, no había mostrado mejoría al tratamiento con esteroides y la serología para otras causas de uveítis fue negativa.…”