Retrobulbar optic neuritis (RON) is an unusual complication of Lyme disease. The diagnosis of early Lyme disease is difficult, and the relationship between RON and Lyme disease remains controversial. None of the 14 cases of optic neuritis described in the literature in association with Lyme disease fulfilled the Halperin and Sibony criteria for active Lyme disease. We report the first case of acute Lyme disease complicated by RON established using the Halperin and Sibony criteria.

Lyme disease is a multisystem infectious disease caused by tick borne spirochetes of the Borrelia burgdorferi group. Diagnosis of this infection can be difficult and serological testing such as western blot can be useful. Cranial neuropathies are common but RON has been reported in a few isolated cases.1 A causal link between optic neuritis and Lyme disease has not been established and remains controversial. We report a case of active neuro-Lyme disease complicated by RON.

Case report

A 67-year-old man who lives in a wooded area of southwest France developed an erythema migrans 3 days after a tick bite on his right arm. He was admitted to hospital 2 weeks later with fatigue, myalgia, painful radiculopathy, facial weakness, ptosis and diplopia. Physical examination showed fever (38°C), cervical radiculoneuropathy with radicular pain and paresis in the right arm, …