# Isolated Optic Neuritis Revealing Lyme Disease in an Adolescent: A Case Report and Literature Review

## TL;DR

A teenager with optic neuritis was found to have Lyme disease, showing the importance of considering this infection in rare neurological cases.

## Contribution

This case report adds to the limited literature on optic neuritis as a rare manifestation of Lyme disease in non-endemic regions.

## Key findings

- A 17-year-old girl with optic neuritis was diagnosed with Borrelia burgdorferi infection.
- Treatment with intravenous ceftriaxone led to near-complete vision recovery without corticosteroids.
- The case emphasizes the need to consider Lyme disease in optic neuritis differential diagnosis.

## Abstract

Lyme disease, caused by Borrelia burgdorferi sensu lato, can occasionally involve the nervous system and lead to a variety of neurological manifestations. Ocular complications are uncommon, and optic neuritis (ON) represents one of the rarest presentations. We describe the case of a 17-year-old girl from Morocco who developed progressive visual loss and eye pain on the right side. Ophthalmologic evaluation revealed unilateral optic disc swelling and macular edema, and magnetic resonance imaging confirmed right optic nerve inflammation. Cerebrospinal fluid analysis demonstrated lymphocytic pleocytosis and elevated protein, while serological and intrathecal testing identified B. burgdorferi infection. The patient was treated with intravenous ceftriaxone for 21 days without corticosteroids and experienced near-complete recovery of vision. This case highlights the importance of considering Lyme disease in the differential diagnosis of ON, even in regions where it is rarely reported. Early recognition and antibiotic therapy can lead to excellent visual outcomes and prevent misdiagnosis as demyelinating disease.