Woman with Lyme disease and vision problems. An Inside Lyme Podcast

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Welcome to an Inside Lyme case study. I find that the best way to get to know Lyme disease is through reviewing actual cases. I will be discussing a 46-year-old woman with Lyme disease and vision problems.

Jha and her colleague first discussed this case in the Wisconsin Medical Journal  in 2018.

A 46-year-old woman developed blurred vision, which progressively worsened over 3 weeks.

She had multiple medical problems hypertension, asthma, posttraumatic stress disorder, depression, seizure disorder, and alcohol use disorder, according to the authors. She had not had a seizure for 25 years.

She did have a history of Lyme disease ten years earlier that was treated for 10 days.

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She described three weeks of worsening blurring of her vision and tingling/numbness of both legs. She also had nausea, weakness, dizziness, and visual hallucinations.

She has seen an optometrist 13 days earlier who found she had optic head edema. She was advised to go to the emergency room. An optic nerve is a nerve that transmits visual information from the retina to the brain.

Did she go? No.

The ophthalmologic exam confirmed the optometrist finding of optic neuritis. Optic neuritis is an inflammation of the optic nerve.

Her vision loss was significant. Legal blindness is defined as having a visual acuity of 20/200 or worse in the better eye after correction. Her visual acuity was 20/400 in both eyes.

She also had an impaired color vision in both eyes.

Lyme disease and vision problems

The blood tests were positive for Lyme disease. Her IgG/IgM antibodies and western blot IgM were both positive. Her western blot IgG was positive for 3 of 10 bands. The CDC required a western blot IgG to be positive on 5 of 10 bands.

The doctor could not find another cause for her optic neuritis. The authors concluded, “Our case also fulfilled the criteria for acute Lyme disease with strong evidence of a causal link with optic neuritis.” wrote the authors. The authors suspected the optic neuritis was new from a presumed tick bite and not from the episode of Lyme disease from 10 years earlier.

The woman was prescribed two weeks of doxycycline but after one week was admitted to the hospital for alcohol intoxication.

“Upon questioning, she endorsed some improvement in vision after initiation of antibiotic,” write the authors.

But the final outcome was uncertain since the woman left the hospital against medical advice and did not adhere to her follow-up appointments.

“Whether her symptoms resolved completely thereafter is unknown,” write the authors.

The authors reminded doctors to include Lyme disease in the differential diagnosis of optic neuritis.

What can we learn from this woman with Lyme disease and vision problems?

1. Lyme disease should be considered in an evaluation of optic neuritis.

What questions does this case of a woman with Lyme disease and vision problems raise?

1. How often does optic neuritis occur in patients with Lyme disease and vision problems?
2. Did the woman get her vision back? She was too non-compliant to determine the outcome. What about other patients with Lyme disease and vision problems?
3. What is the best treatment for Lyme disease and vision problems including optic neuritis? She was prescribed oral doxycycline for two weeks

Treating Tick-Borne Disease

We need more doctors with skills recognizing a tick-borne illness in an individual with Lyme disease and vision problems. We hope that professional evaluating individuals with Lyme disease and vision problems can use this case to remind them to look for tick-borne illnesses and treat accordingly.