Related Experiment Video
Updated: May 19, 2026
Detecting the Lyme Disease Spirochete, Borrelia Burgdorferi, in Ticks Using Nested PCR
Published on: February 4, 2018
Case report: papillitis as the sole ocular sign in Lyme disease
Katherine McVeigh1, Georgios Vakros
1Department of Ophthalmology, Raigmore Hospital, Inverness, United Kingdom.
Background:
Lyme disease is a spirochetal disease responsible for a multitude of ocular and systemic manifestations, and patients may present to ophthalmologists and general clinicians with a wide variety of generalized and ocular signs which can result in chronic and disabling sequelae. Here we report two cases of patients suffering with Lyme disease who developed a rare associated papillitis.
Methods:
A 48-year-old Scottish man presented with diminished visual acuity, painful ocular eye movements, photophobia, and mild ataxia. Fundus examination revealed bilateral disc swelling with associated hemorrhages in the right eye. Following exclusion of raised intracranial pressure as the cause of the findings, enzyme-linked immunosorbent assay and Western blot serology confirmed a positive result for Borrelia burgdorferi which, along with ophthalmic signs and exposure to an endemic area, confirmed the diagnosis of Lyme disease. A 79-year-old gentleman presented with intermittent short-duration "gray film" in his left eye. Fundus examination revealed left optic disc swelling. He was positive for Lyme's serology and his condition was treated with 2 weeks of intravenous ceftriaxone.
Results:
The first patient's inflammation resolved and visual acuity returned to normal following a course of high-dose steroids and intravenous ceftriaxone, followed by oral doxycycline. The second patient's condition improved with high-dose intravenous ceftriaxone.
Conclusion:
These patients highlight the fact that Lyme disease should be considered as a differential diagnosis for patients presenting with papillitis. With the incidence of this disease rising and more cases being reported, practitioners in Lyme-endemic areas need to be aware of the various manifestations so that appropriate referrals for treatment can be made.
Insights
Lyme disease can cause rare papillitis, an optic nerve inflammation. Early diagnosis and treatment are crucial for vision recovery in patients presenting with these Lyme disease symptoms.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Neurology
Background:
- Lyme disease, a spirochetal infection, presents with diverse systemic and ocular manifestations.
- Ocular signs of Lyme disease can lead to chronic and disabling complications if not managed promptly.
Observation:
- Two cases of Lyme disease presenting with rare papillitis (optic disc swelling) are detailed.
- Patients exhibited symptoms including decreased visual acuity, photophobia, and ataxia, alongside characteristic fundus findings.
Findings:
- Diagnosis was confirmed via serological testing for Borrelia burgdorferi.
- Treatment with intravenous ceftriaxone, steroids, and doxycycline led to resolution of inflammation and visual recovery in affected patients.
Implications:
- Papillitis should be considered in the differential diagnosis for patients with Lyme disease.
- Increased awareness of Lyme disease's varied manifestations is essential for clinicians in endemic regions to ensure timely and appropriate patient management.
Related Concept Videos
01:27Myocarditis II: Clinical Features and Diagnostic Tests
01:25Endocarditis II: Clinical Features of Infective Endocarditis
01:22Microbiome of the Eye
01:26Sexually Transmitted Infections
01:19Encephalitis l: Introduction