SHM Converge Scientific Abstract ePoster Gallery-Ocular Lyme Borreliosis: Mimicker or Trigger?

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An 80-year-old woman presented with sudden right-sided weakness, expressive aphasia, and partial vision loss in the left eye. Her neurologic symptoms resolved within an hour, but the visual deficit persisted. Initial CT, CTA, CTP, and MRI studies were negative for acute stroke or structural abnormalities. She had no classic giant cell arteritis (GCA) symptoms such as headache, jaw claudication, or temporal tenderness.<br /><br />Ophthalmic testing showed optic disc edema and visual field defects, especially in the left eye. Laboratory workup revealed mildly elevated ESR and CRP, positive Lyme serology with confirmatory Western blot, and a mildly elevated ANA; other infectious and autoimmune tests were negative. Because Lyme neuroborreliosis can rarely present with papilledema or optic disc edema, she was treated with 4 weeks of antibiotics (IV ceftriaxone followed by oral doxycycline) plus a steroid taper.<br /><br />Her optic disc edema improved after treatment, but her vision did not fully recover. A temporal artery biopsy later confirmed classic GCA, showing mononuclear inflammation, giant cells, and elastic lamina fragmentation; silver stain for spirochetes was negative. She was then started on tocilizumab and a rapid steroid taper to reduce recurrence and further vision loss.<br /><br />The case highlights an unusual presentation of GCA with transient ischemic symptoms and vision loss in the setting of positive Lyme testing. The authors conclude that although Lyme infection may mimic or potentially trigger GCA-like vasculitis, the biopsy-confirmed diagnosis supports true GCA. Spirochetal infections should be considered in the evaluation of suspected GCA, especially when the presentation is atypical.

Asset Subtitle

Sneha Gupta

Meta Tag

Author List Alexandra Chop, Niveditha Mohan, Sneha Gupta

Category Clinical Vignettes

Concept Anterior Ischemic Optic Neuropathy

Concept Optic Neuritis

Concept Giant Cell Arteritis

Concept Sudden vision loss

Concept Lyme Neuroborreliosis

Distinguished Non-Finalist

Presenter Organization University of Pittsburgh Medical Center

Presenting Author Sneha Gupta

Track Adult

Keywords

giant cell arteritis

Lyme neuroborreliosis

optic disc edema

vision loss

transient ischemic attack

temporal artery biopsy

expressive aphasia

optic neuropathy

ceftriaxone

tocilizumab

Anterior Ischemic Optic Neuropathy

Optic Neuritis

Giant Cell Arteritis

Sudden vision loss

Lyme Neuroborreliosis