Abstract
Purpose :
A recent change in the Red Book: 2018-2021 Report of the Committee on Infectious Diseases now recommends either oral doxycycline (DCN) or intravenous ceftriaxone (IV CTX) for treatment of pediatric Lyme meningitis irrespective of neuro-ophthalmologic involvement. We describe three cases which highlight the challenges of managing pediatric Lyme meningitis with neuro-ophthalmic complications.
Methods :
Retrospective case series
Results :
Three pediatric patients - < 18 years of age with symptoms suggestive of meningitis, positive 2-tier Lyme serology (ELISA and western blot), +/- cerebrospinal fluid Lyme antibodies, and neuro-ophthalmologic complications (optic nerve edema +/- cranial nerve palsy) - were treated with either DCN or IV CTX initially. Case 1 (Figure 1, A) had optic nerve edema which worsened after 10 days of DCN treatment, necessitating advancement of treatment to IV CTX. Case 2 (Figure 1, B) had persistent grade 4 papilledema and cranial nerve six 6 palsy (CN6P), requiring a prolonged course of treatment with IV CTX. Case 3 (Figure 1, C) developed a new CN6P along with grade 4 papilledema OU after being treated initially with DCN. All three patients ultimately completed treatment with IV CTX to remove the confounding factors associated with use of DCN, and all had resolution of optic nerve edema and CN6P.
Conclusions :
Cases of pediatric Lyme meningitis with neuro-ophthalmic complications are difficult to treat. The recent change in treatment recommendations allowing use of DCN as first line therapy further complicates initial treatment and subsequent management of systemic and eye disease associated with Lyme infection.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.