Lyme Borreliosis as a cause of bilateral neuroretinitis with pronounced unilateral stellate maculopathy in a 8-year old girl
Abstract
Neuroretinitis is a less-known clinical entity presenting with inflammatory disc oedema and stellate maculopathy. It can be confused with papillitis, papilloedema, retinal periphlebitis in sarcoidosis, hypertensive retinopathy as well as with retinal vein occlusion or anterior ischemic optic neuropathy.
It is most often associated with viral infections and cat-scratch fever, less common with syphilis and Lyme disease. The authors describe the clinical course of neuroretinitis in a 8-year-old girl who was referred to eye clinic with acute painless reduced corrected visual acuity (6/36) in the right eye.
Ophthalmic examination revealed stellate macu-lopathy of the right eye and bilateral neuritis and periphlebitis, imitating sarcoidosis. Nevertheless, sarcoidosis was excluded by biochemical blood examination and lung ima-ging stu-dies.
It was not before detailed biochemical, cytological, immunological, viral and bacterial examination of cerebrospinal fluid were obtained that the diagnosis of Lyme neurro-boreliosis was confirmed. Knowledge of the typical ocular fundus picture in Lyme disease is essential for differential diagnosis of neuroretinitis.
Our case report is a typical example of mutual collaboration between an ophthalmologist and neurologist that is essential for prompt clinical diagnosis and early referral for appropriate therapy.