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Borrelia burgdorferi and serpiginous chorioretinitis - a case report

Kaloyana Shangova, Polina Kapitanska, Rostislava Markova, Yana Manolova

Abstract

Introduction: Serpiginous chorioretinitis is a rare form of posterior uveitis characterised by a geo­graphic destruction of the choroid and the retinal pigment epithelium (RPE). Subsequent destruction of the retina leads to permanent visual loss, especially when the disease involves the macula.

Materials and Methods: The aim of this report is to provide an overview of a case of serpiginous cho­rioretinitis associated with Borrelia burgdorferi in a 19-year-old female without any history of mite bites. The patient was examined at the Specialised Eye Hospital in Varna. The initial symptoms were redness, irritation and pain in the right eye. The patient was diagnosed with anterior uveitis. The fol­lowing topical medications were prescribed - Maxidex, Indocollyre, and Cyclogyl in addition to sys­temic per os therapy - Valtrex. However, after a few days both of the eyes got affected. The ophthalmo­logical examination revealed best corrected visual acuity (BCVA) in right eye- 0,3 and BCVA in left eye- 0,7, normal eye pressure, conjuctival mixed injection, corneal oedema with precipitates, Tyndall effect and the presence of cells in the anterior chamber, lens pigmentation at 6 o’clock, fundus- multi­ple plaques located in the perifoveal areas which appeared one week after the initial symptoms. Opti­cal coherence tomography (OCT) showed decreased retinal thickness and hyperdense areas between the RPE and the inner nuclear layer. Serological test were performed. While waiting for the results, systemic therapy with corticosteroids was initiated.

Results: The serology examination revealed boundary values for Borrelia burgdorferi. A consultation with an Infectious Disease specialist was held. The corticosteroid therapy had a good influence on the condition by reducing the infiltrates. Eventually some of them disappeared completely while oth­ers become plaques. Differential diagnosis included Serpiginous chorioretinitis and White Dot Syn­dromes.

Conclusion: Despite being quite uncommon, Borrelia burgdorferi should always be considered as a possible cause of posterior white dot chorioretinitis.


Keywords

chorioretinitis; Borrelia burgdorferi; White dot syndromes; corticosteroids; uveitis




DOI: http://dx.doi.org/10.14748/ssvs.v2i0.4677

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