Optic Neuritis is a rare manifestation of Neuroborreliosis and we present the only case in the literature diagnosed by the gold standard two-tier testing procedure of ELISA and Immunoblot. A previously fit 50-year-old theology teacher had a flu-like illness in January 2010 and suffered from fatigue for 2 months. In April he had right arm and facial paraesthesia. MRI Brain was unremarkable. He was fitted with a pacemaker in September as long pauses were discovered on Holter monitoring. In October he developed painful eye movements and over the course of a few days his visual acuity and colour vision deteriorated and he was diagnosed with optic neuritis.
Two months later he presented to the neurology department with a 3 week history of bladder and bowel dysfunction, ascending sensory symptoms and leg weakness. Physical examination revealed a spastic paraparesis. CSF consisted mainly of lymphocytes (283 µl), an elevated protein (1.11) and occasional plasma cells. He had strongly positive serum and CSF IgM and IgG titres for borrelia on both ELISA and immunoblot testing. He had a previous tick bite and had numerous exposures in Germany, Hungary and the New Forest. He was treated with intravenous ceftriaxone and he improved such that he could walk again. This case demonstrates the clinical heterogeneity of Neuroborreliosis and earlier recognition of this as a cause of optic neuritis could prevent development of more devastating consequences such as transverse myelitis.
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