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Amilia Schrier, Edward Smith, Sibte Burney, Leejee Han Suh, Carrie Zaslow; Unknown Active Lyme Disease in a Corneal Donor: Two Case Reports. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3138.
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To describe a clinical challenge associated with utilizing donor tissue.
Retrospective case review of two patients who received corneas from a donor with active Lyme disease (LD).
Two patients, an 84 year old female and a 22 year old female underwent penetrating keratoplasty (PK) at two institutions on the same day. The 34 year old donor was routinely screened; preliminary cause of death was Wolf Parkinson White. Uneventful PKs were performed and standard post-operative courses ensued. Four weeks post PK, the eye bank notified the treating physicians that post-mortem studies of the donor revealed positive Lyme IgM titers, reactive IgG titers and an EIA of 5.86, thought to be strongly positive. History of LD exposure in the donor was subsequently confirmed. Subsequent PCR analysis of the donor by the city’s health department was positive, indicating active Borreliosis at the time of death. The donor’s cause of death was changed to myocarditis due to LD. The recipients were immediately notified and scheduled for infectious disease consults. IgM and IgG titers were drawn and the patients were started on Doxycycline 100mg BID. The patients completed a course of 4-6 weeks of medication. Follow-up titers at 2 months remained negative for LD. They will continue to be monitored for signs of disease.
While no known transmission of LD has been reported from PK, Borrelia Burgdorferi has been isolated in human corneas and all donors with known active LD should be excluded. However, in this case, there was no suspicion for LD in the donor at the time of death. This case illustrates a clinical challenge in transplantation and emphasizes the need for an exhaustive medical history and physician-patient communication.
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