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Clinical Reasoning: A 58-Year-Old Woman With Painless Blurry Vision.

Created on 19 Jun 2026

Authors

Christian Diaz Curbelo, Peter Weseley, Steven L Galetta, Scott N Grossman

Published in

Neurology. Volume 107. Issue 1. Pages e218244. Jul 14, 2026. Epub Jun 18, 2026.

Abstract

A 58-year-old woman presented with painless progressive bilateral blurred vision, worse in the right eye, over several days. Two months prior, she developed a diffuse pruritic rash that spared her face. On examination, she was found to have reduced visual acuity bilaterally, optic nerve edema, anterior uveitis, and scattered intraretinal and peripapillary nerve fiber layer hemorrhages. Diagnostic evaluation demonstrated optic nerve head enhancement on MRI. Her serum workup showed positive antibodies for Borrelia burgdorferi with a negative Lyme disease Western blot and positive Treponema pallidum antibodies with an rapid plasma reagin titer of 1:1,024. CSF showed normal protein, a slight elevation in nucleated cells with lymphocytic predominance, and a negative Venereal Disease Research Laboratory. We examine the differential diagnosis for bilateral optic nerve edema and uveitis and explore challenges around interpreting diagnostic testing for a neuro-ophthalmic pathology of ongoing public health interest.

PMID:
42314100
Bibliographic data and abstract were imported from PubMed on 19 Jun 2026.

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