[Keratitis in Lyme disease]

The authors report the case of a 15-year-old female suffering from bilateral keratitis revealing Lyme's disease, 6 years after a tick bite. The corneas disclosed multiple hazy infiltrates adjacent to the limbus and in the midperiphery, from the superficial layers to pre-Descemet's membrane. The other systems involved were the joints, the skin (an atypical erythema chronicum migrans), and perhaps the peripheral nerves. The diagnosis was confirmed by indirect immunofluorescence assays in the serum of the patient who completely and rapidly healed with amoxicillin and systemic and topical steroids. The clinical and serological pitfalls which explain the frequent delayed diagnosis of Lyme's disease, its complications, especially ocular, and the therapeutic strategies are discussed.