Transient worsening of optic neuropathy as a sequela of the Jarisch-Herxheimer reaction in the treatment of Lyme disease.
A 58-year-old woman developed neurologic and neuroophthalmologic manifestations of Lyme disease, including a radiculomyelitis, cranial neuritis and mild right optic neuropathy. Upon treatment with intravenous ceftriaxone a Jarisch-Herxheimer reaction occurred with encephalopathy, mild fever, worsening radiculomyelitis, and deterioration of her visual acuity. Intravenous methylprednisolone was given, and the visual acuity recovered over 72 hours. This case suggests that transient worsening of optic neuropathy can develop as a sequela of the Jarisch-Herxheimer reaction in the treatment of Lyme disease.
Department of Ophthalmology, Montefiore Medical Center, Bronx, NY 10467.
M B
MB
Strominger
T L
TL
Slamovits
S
S
Herskovitz
R B
RB
Lipton
D002443:Ceftriaxone / Q000009:adverse effects* / Q000627:therapeutic use; D004679:Encephalomyelitis / Q000209:etiology; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D008193:Lyme Disease / Q000150:complications / Q000188:drug therapy*; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D009901:Optic Nerve Diseases / Q000209:etiology* / Q000503:physiopathology; D011843:Radiculopathy / Q000209:etiology; D014792:Visual Acuity / Q000187:drug effects
D002443:Ceftriaxone; D008775:Methylprednisolone