Wilk C M, Bialasiewicz A A, Ruprecht K W, Naumann G O
Augenklinik mit Poliklinik, Universität Erlangen-Nürnberg.
Klin Monbl Augenheilkd. 1989 Feb;194(2):88-96. doi: 10.1055/s-2008-1046342.
Two patients with bilateral extensive confluent choroidal lesions, exudative retinal detachments, positive lyme serology and a typical history are documented: A 32-year-old woman presented 14 days after a "flu-like" illness with bilateral acute extensive choroidal lesions and exudative retinal detachments (OD from 5 to 8:30 o'clock, OS from 5 to 8 o'clock, both including the macula) accompanied by a mild lymphocytic meningitis. The laboratory work-up revealed increased serum and CSF titers of antibodies against Borrelia burgdorferi (Lyme immunofluorescent test (IFT) and Lyme-IgM IFT) which declined after a 14-day treatment with doxycycline (200 mg/d), CSF titers non-detectable (serum IgG: from 1:640 to 1:320, serum IgM: from 1:40 to 1:20). A distinct improvement with visual acuity increasing from OD 0.2/OS 0.3 p to OD/OS 0.8 p was observed after seven days of treatment. A 40-year-old man with a 14-day history of tick-bite developed the same, though more severe ocular findings and a lymphocytic meningitis. The serological work-up revealed increased antibody titers against Borrelia burgdorferi (ELISA); the IgM titer was normal. After a 10-day treatment with penicillin, antibody titers against the spirochete decreased slightly and the patient's neurologic and ophthalmologic status improved dramatically. Five weeks after admission visual acuity was OD/OS 0.5 (compared to OD/OS 0.1) and has remained at 0.8 p (OD/OS) since the ninth week after onset. The clinical course of the disease and the decreasing lyme serology strongly suggest an infection with Borrelia burgdorferi. The authors propose thorough laboratory work-ups including tests for Lyme disease in selected patients with diffuse choroidal lesions.
记录了两名双侧广泛融合性脉络膜病变、渗出性视网膜脱离、莱姆血清学阳性且病史典型的患者：一名32岁女性在出现“流感样”疾病14天后就诊，表现为双侧急性广泛脉络膜病变和渗出性视网膜脱离（右眼从5点至8点30分，左眼从5点至8点，均累及黄斑），伴有轻度淋巴细胞性脑膜炎。实验室检查显示抗伯氏疏螺旋体抗体的血清和脑脊液滴度升高（莱姆免疫荧光试验（IFT）和莱姆IgM IFT），在接受多西环素（200mg/d）治疗14天后下降，脑脊液滴度无法检测到（血清IgG：从1:640降至1:320，血清IgM：从1:40降至1:20）。治疗7天后视力明显改善，右眼视力从0.2/左眼0.3提升至右眼/左眼0.8。一名40岁男性有蜱叮咬史14天，出现了相同但更严重的眼部表现及淋巴细胞性脑膜炎。血清学检查显示抗伯氏疏螺旋体抗体滴度升高（ELISA）；IgM滴度正常。接受青霉素治疗10天后，抗螺旋体抗体滴度略有下降，患者的神经和眼科状况显著改善。入院五周后视力为右眼/左眼0.5（入院时为右眼/左眼0.1），自发病第九周起一直维持在0.8（右眼/左眼）。疾病的临床病程及莱姆血清学下降强烈提示伯氏疏螺旋体感染。作者建议对选定的弥漫性脉络膜病变患者进行全面的实验室检查，包括莱姆病检测。
