Optic neuropathy in children with Lyme disease.
Involvement of the optic nerve, either because of inflammation or increased intracranial pressure, is a rare manifestation of Lyme disease. Of the 4 children reported here with optic nerve abnormalities, 2 had decreased vision months after disease onset attributable to optic neuritis, and 1 had headache and diplopia early in the infection because of increased intracranial pressure associated with Lyme meningitis. In these 3 children, optic nerve involvement responded well to intravenous ceftriaxone therapy. The fourth child had headache and visual loss attributable to increased intracranial pressure and perhaps also to optic neuritis. Despite treatment with ceftriaxone and steroids, he had persistent increased intracranial pressure leading to permanent bilateral blindness. Clinicians should be aware that neuro-ophthalmologic involvement of Lyme disease may have significant consequences. If increased intracranial pressure persists despite antibiotic therapy, measures must be taken quickly to reduce the pressure.
Rothermel
H
H
Division of Rheumatology/Immunology, Tufts University School of Medicine, New England Medical Center, Boston, MA 02111, USA.
Hedges
T R
TR
Steere
A C
AC
D000293:Adolescent; D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001766:Blindness / Q000209:etiology; D002648:Child; D004797:Enzyme-Linked Immunosorbent Assay / Q000706:statistics & numerical data; D005260:Female; D005654:Fundus Oculi; D006801:Humans; D008193:Lyme Disease / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D008297:Male; D009798:Ocular Hypertension / Q000175:diagnosis / Q000209:etiology; D009896:Optic Atrophy / Q000175:diagnosis / Q000209:etiology; D009901:Optic Nerve Diseases / Q000175:diagnosis / Q000209:etiology*; D009902:Optic Neuritis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D010211:Papilledema / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology
D000900:Anti-Bacterial Agents