Objective:

Lyme disease is a rare multi-systemic infection and like in many other countries, in Mexico it is rarely considered in the differential diagnosis of certain forms of uveitis due to lack of knowledge about the risk factors of Borrelia burgdorferi infection. This report aims to review such risk factors, the clinical characteristics of ocular involvement, as well as the keys to suspect the disease in susceptible patients.

Observations:

A 4-year-old female with a 6-week history of bilateral red eye and blurred vision. The patient referred muscular and joints pain, skin rash, and respiratory symptoms 10 weeks before. She was previously treated for bilateral panuveitis with topical and systemic steroids during 20 days without improvement. Visual acuity was 20/200, with 3+ cells in the anterior chamber, and 2+ diffuse vitritis. Blurred right disk margins, perivascular sheathing, and multiple chorioretinal white-cream-colored infiltrates in the peripheral retina of both eyes. Multifocal chorioretinitis, papillitis, and vasculitis were diagnosed with a positive serology for B. burgdorferi. Treatment consisted in 250 mg of oral amoxicillin every 8 h for 3 weeks, with complete resolution of inflammation.

Conclusions:

The diagnosis of Lyme disease at early stages is difficult due to its unspecific signs and inconsistent serology. Uveitis due to B. burgdorferi must be considered in every patient at risk who presents with neuro-ophthalmologic manifestations associated with chronic bilateral uveitis refractory to steroid therapy.

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