Title : Diseminated lyme disease: A rare presentation of bilateral optic neuritis and sinus bradycardia without any conduction defects
Abstract:
Lyme disease (Lyme borreliosis) is a multisystem zoonotic disease caused by the spirochete Borrelia burgdorferi. Individuals without treatment may progress to a disseminated stage having cardiac, neurological or another systemic manifestations. We present a rare case of a 40-year-old white woman from Monterrey, Mexico without medical history. She presented to the emergency department with progressive onset of bilateral vision loss, headache and tingling/numbness of her bilateral lower and upper extremities. She also reported episodes of sudden loss of consciousness for 8 weeks. In the emergency room, sinus bradycardia without evident metabolic alterations is detected and dilated fundus exam demonstrated bilateral optic head edema, hyperemia, and optic nerve elevation. After extensive workup and ruling out other neurological and cardiac alterations, she was diagnosed with Lyme Disease with elevated serum IgM antibodies of 30.55 UR/mL (reference 0.00- 22), and the Western blot was positive for serum IgM Lyme antibodies but negative for IgG antibodies. More specifically, 2 bands (P21 IgM and P25[Osp C] IgM) were positive in addition to the positive Western blot, which fulfilled the Centers for Disease Control and Prevention (CDC) recommendation for a positive Lyme test. Due to the persistence of symptoms a lumbar puncture was performed, and showed normal opening pressure; glucose and protein levels were within normal limits but there was mild cerebrospinal fluid (CSF) pleocytosis with lymphocyte predominance. She was treated with doxycycline for 2 weeks. She was discharged home in stable condition with outpatient neuroophthalmology and cardiology follow-up.
