Author(s)

Ihtesham A. Qureshi^1*, Michael F. Maldonado², Gustavo J. Rodriguez¹, Salvador Cruz-Flores¹, Alberto Maud¹

¹Neurology Department, Texas Tech University Health Sciences Center, El Paso, USA.
²Ophthalmology Department, Texas Tech University Health Sciences Center, El Paso, USA.

Objective: We describe a patient diagnosed with acute neuroborreliosis presenting with anterior optic neuritis (papillitis) in a non-endemic region. Case Presentation: A 43-year-old previously healthy right handed man admitted due to an insidious onset of severe headache and spells of ascending paresthesias from his right foot into his right arm and face followed by speech arrest and clumsiness of his right hand. His neurologic exam was significant for somnolence, nuchal rigidity and Kernig and Brudzinski signs were present. MRI of the brain with gadolinium showed diffuse hyperintense signal involving the supra and infratentorial cortical sulci, with associated faint diffuse leptomeningeal enhancement, consistent most likely with diffuse leptomeningoencephalitis. EEG: normal. CSF VDRL was negative. Dilated fundus exam revealed mild optic nerve edema more significant to the left than to the right eye, confirmed and measured by spectral domain OCT (Optical Coherence Tomography). There was an evidence of posterior uveitis with an early vitreous hemorrhage superficial to the left optic nerve. Lyme disease serum antibody (IgM) Immunoblotting was positive in 2 bands confirming the diagnosis of neuroborreliosis. Conclusion: Optic nerve involvement in Lyme disease is an uncommon complication that should be confirmed by specific diagnostic criteria to establish its causal relation.

Optic Neuritis, Lyme Disease, Non-Endemic, Papillitis

Qureshi, I. , Maldonado, M. , Rodriguez, G. , Cruz-Flores, S. and Maud, A. (2016) Optic Neuritis in Acute Neuroborreliosis (Lyme Disease) in the U.S.-Mexican Border: Case Report. World Journal of Neuroscience, 6, 126-130. doi: 10.4236/wjns.2016.62016.