Uveitis and lyme disease: About two case reports

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PurposeLyme disease (LD) is a spirochete anthropozoonosis transmitted by tick bite. The ocular manifestations are diverse although rare. Uveitis is one of the most frequent.MethodsTwo patients 46 and 52 years, referred for unlabeled and steroid dependent uveitis were studied. The first had two previous episodes of uveitis straight herpes diagnosed in early 2011. The second was treated with oral corticosteroids for chronic bilateral panuveitis evolving since February 2010, with a first anterior uveitis in 1989 (unavailable negative test). Laboratory tests with viral serology Quantiferon, IDR, syphilis serology and FAN have been made.ResultsThe first patient had a visual acuity preserved, bilateral vitritis and a right anterior uveitis with pigmented keratic precipitates. The fundus and OCT were normal, angiography showed a left papillary hyperfluorescence. The autoimmune hypothesis had been raised with centromere antibody positive before having a positive IgM ELISA Lyme serology confirmed by a Western Blot (WB). The second patient had bilateral visual loss, right ocular hypertension associated with diffuse bilateral anterior synechiae on a plot of uncontrolled glaucoma. There was a serous retinal detachment in right fundus. The B-scan ultrasonography showed bilateral posterior scleritis. She was treated with solumedrol before the positive IgG ELISA and WB. No tick bite was mentioned, but walks in the forest were found.ConclusionThe diagnosis of Lyme disease must be suspected in the face of recurrent uveitis even without a tick bite. Specific serology may be positive if completed, allowing antimicrobial therapy.

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