SHM Converge Scientific Abstract ePoster Gallery-Optic Neuritis: An Eye-Opening Manifestation of Lyme Disease

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This report describes a rare pediatric case of optic neuritis caused by Lyme disease. A 5-year-old boy presented with one month of headaches, decreased visual acuity, reduced color vision, and one day of vomiting. Examination showed bilateral optic disc edema and severe vision loss. Initial workup, including CT, lumbar puncture, and broad infectious, autoimmune, and demyelinating studies, was largely unrevealing. MRI of the brain and orbits demonstrated bilateral optic nerve swelling consistent with optic neuritis.<br /><br />Although he lacked typical Lyme symptoms such as erythema migrans, joint pain, or muscle aches, serum Lyme IgG was positive and later Lyme Western blot testing of serum and CSF supported the diagnosis. Other findings, including positive toxoplasma IgG and CSF oligoclonal bands, were not supported by the clinical picture. The patient was treated first with high-dose IV steroids, followed by an oral prednisone taper and then doxycycline for two weeks per Lyme treatment guidelines. His headaches improved quickly, and vision gradually recovered from 20/800 and 20/100 to 20/30 in both eyes with normal color vision.<br /><br />The authors note that pediatric optic neuritis is uncommon and has many possible causes, but Lyme-associated optic neuritis is especially rare, with only a few published pediatric cases. This case is notable because it appears to be the first reported pediatric Lyme optic neuritis without classic Lyme manifestations. The report emphasizes that Lyme disease should remain in the differential diagnosis for optic neuritis, particularly in endemic regions, because prompt recognition and treatment may prevent permanent vision loss.

Asset Subtitle

Amber Vozar

Meta Tag

Author List Amber Vozar, Brianna Skaff, Giles Knowles, Martin Weisse MBA, MD, Morgan Decker, Vincent Arnone MD

Category Clinical Vignettes

Concept Pediatric Optic Neuritis

Concept Lyme Disease

Concept Irreversible Blindness

Concept Clinical Presentation

Concept Diagnostic Evaluation

Distinguished Non-Finalist

Presenter Organization WVU Medicine

Presenting Author Amber Vozar

Track Pediatric

Keywords

Lyme disease

pediatric optic neuritis

optic neuritis

optic disc edema

vision loss

bilateral optic nerve swelling

Western blot

doxycycline treatment

high-dose IV steroids

endemic regions

Pediatric Optic Neuritis

Lyme Disease

Irreversible Blindness

Clinical Presentation

Diagnostic Evaluation