PDF(Pubmed)
Abstract：
Acute vision loss is a prevalent clinical manifestation associated with a broad spectrum of differential diagnoses, encompassing demyelinating diseases, neoplastic processes, autoimmune disorders, and infectious conditions. A rare but noteworthy infectious etiology contributing to acute vision loss is neurological Lyme disease (Lyme neuroborreliosis)-induced optic neuritis. Lyme disease, a vector-borne illness caused by the spirochete Borrelia burgdorferi, has the potential to affect multiple physiological systems and unfolds in three distinct stages. Another significant contributor to acute vision loss is giant cell arteritis, an autoimmune vasculitis that commonly affects large- and medium-sized vessels, including the temporal and ophthalmic arteries. This relatively common condition may manifest with symptoms, such as jaw claudication, headaches, and visual disturbances. The precise identification of the underlying cause of acute visual loss is of utmost importance for physicians, as it is instrumental in averting undesirable complications. An 80-year-old female presents to the emergency room with a sudden onset of blurry vision of the left eye, right-sided weakness, dysarthria, jaw pain, headache, and left facial droop. Following consultations with rheumatology and ophthalmology specialists, giant cell arteritis emerged as a primary consideration in the differential diagnosis for the observed vision loss. Subsequently, a temporal artery biopsy was conducted, definitively confirming the diagnosis of giant cell arteritis. Considering the patient\'s residence in an area endemic to Lyme disease, a Lyme immunoglobulin G (IgG) titer was ordered. The results returned positive, suggesting the presence of Lyme neuroborreliosis.
摘要：
急性视力丧失是与广泛的鉴别诊断相关的常见临床表现。包括脱髓鞘疾病，肿瘤过程，自身免疫性疾病，和传染性条件。导致急性视力丧失的一种罕见但值得注意的感染性病因是神经性莱姆病（莱姆病）引起的视神经炎。莱姆病,由螺旋体伯氏螺旋体引起的媒介传播疾病，有可能影响多个生理系统，并在三个不同阶段展开。急性视力丧失的另一个重要原因是巨细胞动脉炎，通常影响大中型血管的自身免疫性血管炎，包括颞动脉和眼动脉.这种相对常见的情况可能表现为症状，比如颌骨跛行,头痛,和视觉障碍。准确识别急性视力丧失的根本原因对医生来说至关重要，因为它有助于避免不良并发症。一名80岁的女性突然出现左眼模糊的视力出现在急诊室，右侧的弱点，构音障碍,下巴疼痛,头痛,左面部下垂。在与风湿病和眼科专家协商后，巨细胞动脉炎是观察到的视力丧失的鉴别诊断的主要考虑因素。随后，进行了颞动脉活检，明确确认巨细胞动脉炎的诊断。考虑到病人居住在莱姆病流行地区,订购了莱姆免疫球蛋白G（IgG）滴度。结果呈阳性，提示存在莱姆病.
