Simultaneous involvement of optic and abducens nerves by Lyme disease: Case report with review of the literature

Abstract

Ocular manifestations of Lyme disease (LD) remain a rare feature of the disease, but it may present a wide range of clinical presentations with different combinations. LD related optic neuritis or cranial nerve (CN) six palsy have been reported in the literature. However, this is the first case report of simultaneous involvement of CN 2 and CN 6 in a patient with LD. The diagnosis of LD can be challenging and initial laboratory tests can be a false negative. It is paramount important to repeat the diagnostic test if clinical suspicious is ongoing. With this case, we aim to increase awareness of clinicians for possible ocular manifestations of LD and its complex diagnostic process.

Case Report: An Isolated Abducens Palsy Secondary to Lyme Disease

“…13 There are also reports of abducens palsy occurring simultaneously with third and fourth nerve palsies, as well as one associated with optic neuritis. [14][15][16] In a recent report from Europe detailing five cases of abducens palsy secondary to Lyme disease, one patient also had a facial palsy, and four had other symptoms of Lyme, including arthritis and arthralgia. Headache was reported in only one of five patients.…”

“…A clinical review in Denmark of 431 cases of neuroborreliosis noted that 43% of patients had a cranial nerve palsy, but out of 187 total palsies, only 8 abducens palsies were noted, and 75% of patients presented with multiple symptoms 13 . There are also reports of abducens palsy occurring simultaneously with third and fourth nerve palsies, as well as one associated with optic neuritis 14–16 . In a recent report from Europe detailing five cases of abducens palsy secondary to Lyme disease, one patient also had a facial palsy, and four had other symptoms of Lyme, including arthritis and arthralgia.…”

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

“…Ocular involvement is usually seen in the 2nd or 3rd stage of the disease. Although relatively uncommon, it could manifest multifariously such as conjunctivitis, keratitis, uveitis, periorbital oedema, cranial nerve II, III, IV, VII palsies, papilledema, reversible Horner’s syndrome, cotton wool spot, vascular occlusion, and optic neuritis [ 9 – 17 ]. Optic neuritis is rare in Lyme borreliosis; therefore, it is often overlooked in the differential diagnosis.…”