Optic disc edema associated with neuroborreliosis

Abstract

Purpose: Optic disc edema as the primary ocular manifestation of Lyme disease is rare. Current knowledge of the presentation and treatment of optic disc edema in neuroborreliosis relies on case reports. This case presents successful treatment of neuroborreliosis associated optic disc edema in a pediatric patient. Observations: We present a case of an 11-year-old female who presented to the ophthalmology clinic with a two-month history of headaches and blurry vision. The patient and accompanying guardian reported a preceding history of fever, rash, and presumed cellulitis, which resolved with cephalexin. There was no visual compromise, strabismus or dysmotility, but bilateral mild optic disc edema was seen on dilated fundoscopic exam. A magnetic resonance imaging (MRI) of the brain and orbits was obtained urgently, which revealed optic perineuritis and enhancement of multiple cranial nerves. Bloodwork and cerebrospinal fluid (CSF) studies were later performed, revealing positive serology for Lyme disease. The patient was then prescribed a 14-day course of oral doxycycline. On initial follow up 1-month later, the patient's subjective blurry vision had resolved, but the optic disc edema had worsened in the left eye. After discussion and shared decision making with the patient's family, the patient was prescribed a short course of oral prednisone. Follow-up 3 weeks later showed resolution of the optic disc edema and no visual abnormalities, and at delayed follow up there was no recurrence of disc edema and a mild, self-limited headache once or twice weekly was her only symptom. Conclusions and importance: This case presents successful treatment of neuroborreliosis associated optic disc edema with doxycycline and oral prednisone in a pediatric patient. Corticosteroids can facilitate the resolution of optic disc edema after antibiotic treatment.