Vision loss, giant cell arteritis, and Lyme neuroborreliosis

This case presentation highlights the importance of considering Lyme disease as a possible cause of vision loss and other neurologic symptoms caused by nerve and vascular inflammation in the head and neck.¹ An 80 year old female with vision loss, headaches, jaw pain, temporal artery tenderness, facial palsy, and limb weakness underwent an extensive diagnostic workup which included Neurology, Ophthalmology and Rheumatology, but did not initially include testing for Lyme disease.

The patient was diagnosed with giant cell arteritis, or GCA, after having a temporal artery biopsy. She was treated with corticosteroids. 

The patient lived in a Lyme endemic area, she had many symptoms of Lyme disease, and her western blot test showed five positive bands. She was subsequently treated for Lyme disease. 

In their discussion, the authors question the primary cause of her vision loss simply because the patient declined to have a lumbar puncture.

Due to the patient’s refusal to undergo lumbar puncture for CSF analysis, a definitive determination regarding the primary etiology of the visual defects remains uncertain. The observed symptomatology raises questions regarding whether the visual impairments are primarily attributed to GCA or if Lyme neuroborreliosis is a contributory factor, given the potential overlap of symptoms.

This case presentation raises questions for further consideration and research. The authors point out previous cases in which patients were diagnosed with, or were initially thought to have had GCA and were later found to have a Lyme infection. Is it possible that the symptoms of GCA and vision loss were both secondary to inflammation and immune responses related to the Lyme infection? This is an important question, because Lyme disease is treated with antibiotics to fight infection, while giant cell arteritis is treated with steroids which can suppress the immune response. 

This paper illustrates the importance of sharing case presentations in order to better understand clinical scenarios like the one presented here. In reviewing this case, one might consider what this patient’s course of treatment would have been had she been diagnosed and treated for Lyme disease before receiving the diagnosis of giant cell arteritis.

This case presentation also reiterates the importance of including Lyme disease in the differential diagnosis when considering the root causes of vision loss and other neurologic symptoms of Lyme disease.

1. Wan L, Yan A, Reese E, et al. (February 05, 2024) Through the Eyes of Uncertainty: Giant Cell Arteritis and Lyme Neuroborreliosis in a Story of Vision Loss. Cureus 16(2): e53623. doi:10.7759/cureus.53623