ro13-9904 and Optic-Nerve-Diseases

Whipple's disease is a systemic disorder caused by an infection with a gram-positive bacillus, Tropheryma whipplei. Almost every organ system can be affected in Whipple's disease, resulting in varying clinical symptoms.. As far as we are aware, this report of a 61-year-old male is the first presenting with a periorbital manifestation of the disease, with severe exophthalmos and optic nerve involvement, leading to rapid visual loss. This emergency case was successfully treated by a surgical orbital decompression combined with systemic use of antibiotics and steroids.. Whipple's disease can affect the periorbital tissues and the optic nerve, causing massive exophthalmos and serious transient visual loss. In such a case surgical decompression of the affected orbit combined with antibiotics and steroids is a recommended valid treatment option.

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Ceftriaxone; Decompression, Surgical; Exophthalmos; Humans; Male; Metronidazole; Middle Aged; Nerve Compression Syndromes; Optic Nerve Diseases; Orbital Diseases; Vision Disorders; Whipple Disease

A 58-year-old woman developed neurologic and neuroophthalmologic manifestations of Lyme disease, including a radiculomyelitis, cranial neuritis and mild right optic neuropathy. Upon treatment with intravenous ceftriaxone a Jarisch-Herxheimer reaction occurred with encephalopathy, mild fever, worsening radiculomyelitis, and deterioration of her visual acuity. Intravenous methylprednisolone was given, and the visual acuity recovered over 72 hours. This case suggests that transient worsening of optic neuropathy can develop as a sequela of the Jarisch-Herxheimer reaction in the treatment of Lyme disease.

Topics: Ceftriaxone; Encephalomyelitis; Female; Fever; Humans; Lyme Disease; Methylprednisolone; Middle Aged; Optic Nerve Diseases; Radiculopathy; Visual Acuity

Four patients from Caribbean and Central American countries with ocular disease and serologic evidence of Lyme borreliosis are discussed. To our knowledge this is the first report of Lyme disease from this geographic area. Two patients exhibited ocular inflammatory disease, and two patients developed optic neuropathy. A brief discussion of Lyme borreliosis, its serologic diagnosis, and its treatment is presented.

Topics: Adult; Aged; Borrelia Infections; Ceftriaxone; Child; Endophthalmitis; Eye Diseases; Humans; Intraocular Pressure; Lyme Disease; Male; Middle Aged; Optic Nerve Diseases; Penicillins; Tetracycline; Visual Acuity; West Indies