NEUROBORRELIOSIS WITH RETINAL-PIGMENT EPITHELIUM DETACHMENTS

Borreliosis or Lyme disease, a tick-borne infection with the spirochet e Borrelia burgdorferi, can cause various ocular and neurological symp toms, A 41-year-old man bad been repeatedly bitten by ticks in June 19 92: 6 months later, the patient complained of blurred vision in both e ves of I-week duration, bifrontal headache that was more pronounced on the right side, and neck pain that had appeared months earlier and wa s becoming more severe. On ophthalmoscopy. clover-shaped retinal pigme nt epithelium detachments around the optic disc were observed in both eyes, The patient's visual acuity was reduced to 0.5 in his left eye. Liquor cells and total protein were significantly increased; however, a hemagglutination inhibition test revealed only moderately increased immunoglobulin values. After 2 weeks of daily application of Ig ceftri axone disodium. ophthalmological and neurological symptoms disappeared . Even though the immunoglobulin values remained unchanged, neuroborre liosis with involvement of the retinal pigment epithelium was the most probable diagnosis, considering the history of tick bites and headach e. The authors assume that the tissue around the optic nerve head. whi ch does not have an effective blood-brain barrier, allowed the spiroch etes to spread from the central nervous system into the subpigment-epi thelium space, thus causing the observed parapapillary pigment epithel ium detachments.