Neuroretinitis as presenting and the only presentation of Lyme disease: Diagnosis and management

Abstract

We present a case of neuroretinitis as presenting and the only presentation of Lyme disease in a 25-year-old female who visited hilly areas in the Himalayas of North India. She presented with right eye sudden and painless blurring of vision. Her vision at presentation was 20/60. She had fundus examination; fundus fluorescein angiography (FFA) and optical coherence tomography (OCT) imaging showed classical features of neuroretinitis. No other organ was involved. Oral steroids were prescribed and relevant investigations sent for noninfective and infective causes. Worsened visual acuity (VA) to hand movement and positive IgM titers for Borrelia burgdorferi led to the diagnosis of Lyme disease-associated neuroretinitis. Treatment with oral doxycycline plus oral steroids for 4 weeks revealed VA of 20/20 and resolution of fundus and OCT changes. Neuroretinitis as presenting and the only presentation of Lyme disease will be discussed with serial fundus, FFA, and OCT pictures.

Post typhoid fever neuroretinitis with serous retinal detachment and choroidal involvement-A case report

“…5 , 6 , 7 Neuroretinitis of other origins like cat scratch and Lyme's diseases has been reported more frequently. 8 , 9 A pathology that incites immune-mediated response can disturb the blood-retinal barrier. 10 It has been hypothesized that a micro emboli can obstruct microcirculation, eventually leading to sluggish blood flow and disc edema.…”

“… 15 , 16 However,the role of steroid has always been controversial in the treatment of infective neuroretinitis due to the lack of literature on this topic. 8 , 9 Mild cases may show spontaneous resolution but severe cases require treatment.…”

Revenge of the Tick: Tick-Borne Diseases and the Eye in the Age of Climate Change and Globalisation

“…Neuroretinitis [73,[117][118][119][120] including interdigitation zone loss [121], has been described in patients with positive Lyme serologies. Complications of neuroretinitis include development of full thickness macular holes and peripapillary retinal pigment epithelium detachments precipitated by optic nerve inflammation and secondary macular oedema [122,123].…”

Lyme Disease Presenting as Ankylosing Spondylitis: A Case Report

“…Previous reports have found Lyme disease presenting as myocarditis [3], neuroretinitis [4], Bell's palsy [5], atrioventricular block [6], neuralgic amyotrophy [7], and sensorineural hearing loss [8].…”