Abstract:
Introduction: Lyme neuroborreliosis (LNB) is a manifestation of Lyme disease
involving the central and peripheral nervous system. It is caused by the spirochete
Borrelia burgdorferi, transmitted by tick bites to a human host. Clinical signs of LNB
develop after the dissemination of the pathogen to the nervous system. The
infection occurs in children often present with facial nerve palsy and/or subacute
meningitis but subacute headache can be the only manifestation of LNB in children.
Non-specific symptoms, such as loss of appetite, fatigue or mood changes, may also
occur, especially in young children. This case presentation provides an overview of
the spectrum of clinical manifestations, diagnosis, antibiotic treatment, and clinical
outcome of LNB in children.
Purpose: Neuroborreliosis may cause various neuro-ophthalmological
complications. Meningitis, intracranial hypertension, and papilledema occur more
commonly in children than adults. We describe a case with a bilateral papilledema
at a 4-years old child after a tick bite.
Case report: A 4-years-old child complaining of headaches, low-grade fever, loss of
appetite and fatigue during 2 weeks after an insect bite. After neurological
examination the child was referred to ophthalmological examination and blood test
for Borrelia burgdorferi. In the serum, raised IgM to Borrelia burgdorferi was
detected. On fundoscopic exam, he was found to have bilateral optic disc swelling
with elevation, blurring, and large vessels crossing elevated margins consistent with
papilledema. Visual acuity was 1.0/1.0, and bilaterally pupillary reactions were
normal. Magnetic resonance imaging (MRI) showed bilateral papilledema and
normal appearance of the brain tissue. He was started on antibiotic ceftriaxone and
azithromycin and completed a total of 14 days of therapy. He did not require any
additional therapies including steroids. Follow-up appointment with
ophthalmoscopy one month after diagnosis revealed improving disc edema.
Conclusions: Isolated papilledema is a rare manifestation of Lyme disease but a high
level of suspicion and early recognition of the various clinical manifestations
presented by children with LNB is essential to minimize delay in diagnosis and
optimize management.
