SHM Converge Scientific Abstract ePoster Gallery-When Eyes Give You Lemons, Consider Adding Lyme

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This case report describes a 75-year-old woman who developed painless blurred vision in her left eye after a febrile illness one month earlier. Initial head CT and MRI were unrevealing, though her ESR was mildly elevated. When she was later evaluated by neuro-ophthalmology, she was found to have asymmetric bilateral optic neuropathy with disc edema, bilateral vision loss worse in the left eye, and a left relative afferent pupillary defect.<br /><br />Serologic testing and Western blot were positive for both IgM and IgG Lyme antibodies, and she was started on oral doxycycline. However, by day 24 she developed new right eye visual deficits. Treatment was escalated to IV methylprednisone and IV ceftriaxone, and doxycycline was stopped. Lumbar puncture showed elevated CSF protein and glucose, with negative culture and PCR, but CSF serology was positive for Lyme antibodies. She was diagnosed with Lyme optic neuritis.<br /><br />The report emphasizes that Lyme disease can present with a wide range of manifestations, including rare ocular involvement such as conjunctivitis, uveitis, and optic neuritis. In neuroborreliosis, diagnosis may be supported by CSF Lyme antibodies or PCR, and treatment typically involves doxycycline or IV beta-lactams.<br /><br />The authors conclude that clinicians should consider Lyme disease in patients with nonspecific ocular symptoms, especially in Lyme-endemic regions, because timely recognition may prevent progression of vision loss.

Asset Subtitle

Adam Kelly

Meta Tag

Author List Adam Kelly, Matthew Aiken, Pinky Jha, Valerie Carter

Category Clinical Vignettes

Concept Lyme Disease

Concept Lyme Neuroborreliosis

Concept Ocular Manifestation

Concept Optic Neuritis

Concept Serologic Test

Distinguished Non-Finalist

Presenter Organization Medical College of Wisconsin

Presenting Author Adam Kelly

Track Adult

Keywords

Lyme disease

optic neuritis

neuroborreliosis

vision loss

optic neuropathy

disc edema

Borrelia burgdorferi

doxycycline

ceftriaxone

ocular involvement

Lyme Disease

Lyme Neuroborreliosis

Ocular Manifestation

Optic Neuritis

Serologic Test