Management Of Neuroretinitis In A Case of Lyme Disease

Abstract

Neuroretinitis in Lyme disease is a rare entity, which is caused by Borrelia burgdorferi. Diagnosis of the disease is based on clinical history, symptoms and serological testing. Here, we present a case of a young 12 year old female suffering from unilateral neuroretinitis associated with Lyme disease characterized by sudden loss of vision, optic disc swelling and macular star. After the diagnosis, the patient received medical therapy and improved well. Early diagnosis and appropriate management of this disease may improve vision with a good outcome. relative afferent pupillary defect in the left eye. Colour vision was defective in the left eye. Extraocular motility and confrontational visual fields were full in both eyes but on Humphry field analyzer, there was centroceacal scotoma noted in the left eye. Intraocular pressure was 12.2mmHg in both eyes. Slit lamp examination of both eyes was unremarkable with no evidence of anterior chamber and anterior vitreous cells. Fundus examination revealed optic disc oedema with hard exudates arranged in a macular star pattern in the left eye (Figure-1a). Fluorescein angiography confirmed our diagnosis of neuroretinitis (Figure-1b). Routine blood investigations were within normal limits but serological testing showed positive IgM antibodies for Borrelia, suggestive of Lyme disease. After diagnosis of the case as neuroretinitis due to Lyme disease, the patient received intravenous infusion of methylprednisolone750mg in 150ml GDW in 45minutes for three consecutive days with intravenous ceftriaxone 500mg QID daily for 21 days. After pulse therapy of methylprednisolone for 3 days, the patient was switched on oral prednisolone with a dose of 20mg once a day with capsule omeprazole 10mg empty Abstract stomach for another 2 weeks. After 3 days of pulse therapy, the patient’s vision improved to the level of 6/6 in the right eye and 6/12 in the left eye, and at 1 month follow up, the patient’s vision was 6/6 in both eyes. After one month post treatment, there was marked decrease in disc oedema noted clinically and angiographically (Figure-2a & 2b). Repeat serological test after one month treatment showed low titer of IgG antibodies and absence of IgM antibodies for Borrelia.