title: [Bilateral acute confluent disseminated choroiditis in Borrelia burgdorferi infection].
abstract: Two patients with bilateral extensive confluent choroidal lesions, exudative retinal detachments, positive lyme serology and a typical history are documented: A 32-year-old woman presented 14 days after a "flu-like" illness with bilateral acute extensive choroidal lesions and exudative retinal detachments (OD from 5 to 8:30 o'clock, OS from 5 to 8 o'clock, both including the macula) accompanied by a mild lymphocytic meningitis. The laboratory work-up revealed increased serum and CSF titers of antibodies against Borrelia burgdorferi (Lyme immunofluorescent test (IFT) and Lyme-IgM IFT) which declined after a 14-day treatment with doxycycline (200 mg/d), CSF titers non-detectable (serum IgG: from 1:640 to 1:320, serum IgM: from 1:40 to 1:20). A distinct improvement with visual acuity increasing from OD 0.2/OS 0.3 p to OD/OS 0.8 p was observed after seven days of treatment. A 40-year-old man with a 14-day history of tick-bite developed the same, though more severe ocular findings and a lymphocytic meningitis. The serological work-up revealed increased antibody titers against Borrelia burgdorferi (ELISA); the IgM titer was normal. After a 10-day treatment with penicillin, antibody titers against the spirochete decreased slightly and the patient's neurologic and ophthalmologic status improved dramatically. Five weeks after admission visual acuity was OD/OS 0.5 (compared to OD/OS 0.1) and has remained at 0.8 p (OD/OS) since the ninth week after onset. The clinical course of the disease and the decreasing lyme serology strongly suggest an infection with Borrelia burgdorferi. The authors propose thorough laboratory work-ups including tests for Lyme disease in selected patients with diffuse choroidal lesions.
authors.affiliation: Augenklinik mit Poliklinik, Universität Erlangen-Nürnberg.
authors.forename: C M
authors.initials: CM
authors.lastname: Wilk
authors.forename: A A
authors.initials: AA
authors.lastname: Bialasiewicz
authors.forename: K W
authors.initials: KW
authors.lastname: Ruprecht
authors.forename: G O
authors.initials: GO
authors.lastname: Naumann
mesh_terms: D000328:Adult; D000907:Antibodies, Bacterial / Q000032:analysis; D001898:Borrelia / Q000276:immunology; D001899:Borrelia Infections / Q000175:diagnosis*; D002833:Choroiditis / Q000175:diagnosis*; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D008297:Male; D012163:Retinal Detachment / Q000175:diagnosis
chemical_list: D000907:Antibodies, Bacterial
vernacular_title: Bilaterale akute konfluierende Chorioiditis disseminata bei Borrelia burgdorferi-Infektion.