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Lana Rifkin, Andrea Birnbaum, Anjali Parekh, Chaisiri Jumroendararasame, Dmitry Pyatetsky, Debra Goldstein; Utility of Lyme Antibody Testing in the Uveitis Workup. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2883. doi: https://doi.org/.
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To determine the utility of testing for Lyme disease in patients with ocular inflammation at single center in the Midwestern United States.
A search of the Electronic Data Warehouse at Northwestern University was performed to identify patients with a diagnosis of uveitis or scleritis evaluated between August 2007 and November 2012 who also had available results of Lyme Enzyme-linked immunosorbent assay (ELISA) or Western Blot testing. Data on clinical presentation, results of diagnostic testing, and final diagnosis were collected.
113 patients with a diagnosis of scleritis or uveitis had available results of Lyme testing. Clinical presentations included anterior uveitis (n=56), intermediate uveitis (n=19), posterior uveitis (n=21), panuveitis (n=11) and scleritis (n-=6). Only 3 patients (2.65%) had positive ELISA for Lyme; 1 patient had an equivocal result. Of these 4 patients, 2 were diagnosed with syphilis and their positive Lyme titers were felt to be due to cross reaction; the other 2 patients were ultimately diagnosed with juvenile idiopathic arthritis and ocular sarcoidosis. No patient had positive Lyme Western blot testing.
Lyme testing is often performed in patients with uveitis and scleritis as part a diagnostic evaluation. In this small series, only 4 of the 113 tested patients had positive ELISA testing, and none were ultimately diagnosed with ocular Lyme disease. No patients had positive Western blot testing. Obtaining Lyme titers in patients with ocular inflammation may have a low yield, at least in non-endemic areas, and should probably be reserved for those patients with a history of tick bite and rash, or other systemic findings suggestive of the diagnosis.
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