TITLE:
Optic Neuritis in Acute Neuroborreliosis (Lyme Disease) in the U.S.-Mexican Border: Case Report
AUTHORS:
Ihtesham A. Qureshi, Michael F. Maldonado, Gustavo J. Rodriguez, Salvador Cruz-Flores, Alberto Maud
KEYWORDS:
Optic Neuritis, Lyme Disease, Non-Endemic, Papillitis
JOURNAL NAME:
World Journal of Neuroscience,
Vol.6 No.2,
May
11,
2016
ABSTRACT: 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.