In their article “Through the Eyes of Uncertainty: Giant Cell Arteritis and Lyme Neuroborreliosis in a Story of Vision Loss,” Wan and colleagues describe a unique case in which an elderly woman, who tested positive for both giant cell arteritis and Lyme disease, developed vision problems including an abrupt loss of vision.¹
An acute loss of vision and other vision problems can be caused by a variety of medical conditions including an autoimmune disorder known as giant cell arteritis (GCA). This is a type of vasculitis whereby certain arteries, particularly those near the temples, become inflamed. It’s a relatively common condition which may cause jaw claudication (pain or fatigue while chewing), headaches, and visual disturbances.
Meanwhile, Lyme disease is one of several infections that can cause vision problems including a sudden loss of vision.
“Although relatively rare, Lyme disease can also lead to optic neuritis, an optic nerve inflammation resulting in eye pain and blurry vision,” the authors point out.
Vision problems due to Lyme disease?
In their case report, the authors describe an 80-year-old woman who was admitted to the emergency department with an abrupt onset of blurry vision of the left eye, right-sided weakness, dysarthria, jaw pain, headache, and left facial droop.
A temporal artery biopsy was performed and confirmed the diagnosis of giant cell arteritis. The patient was treated with high dose corticosteroids which improved her unilateral vision loss but only slightly.
Since the woman lived in a Lyme endemic region, clinicians ordered testing for Lyme disease, which was positive.
“Surprisingly, the Lyme IgG returned positive in five bands on the Western blot, suggesting a diagnosis of Lyme neuroborreliosis,” the authors state.
The patient was treated for Lyme disease with IV ceftriaxone, followed by oral doxycycline.
“Upon discharge, the patient’s vision in the left eye remained reduced but was improving and stable,” states Wan et al.
“Acute vision loss can be a rare manifestation of Lyme disease.”
The authors suggest, “It is less likely that the patient’s ocular symptoms were attributable to Lyme neuroborreliosis, particularly considering the improvement observed after a high dose of steroids. However, the possibility cannot be entirely ruled out…”
Authors Conclude:
“Healthcare providers in a Lyme endemic area must include Lyme disease in their list of differential diagnoses when assessing patients with acute vision loss/disturbance, as there exists a risk of it being either undiagnosed or overshadowed by other presenting illnesses with analogous symptoms, such as [giant cell arteritis] GCA.”
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References:
- Wan L, Yan A, Reese E, et al. (February 05, 2024) Through the Eyes of Uncertainty: Giant Cell Arteritis and Lyme Neuroborreliosis in a Story of Vision Loss. Cureus 16(2): e53623. doi:10.7759/cureus.53623
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