Borrelia persica–associated intraocular infection following a relapsing febrile illness: a case report

Purpose To describe the clinical course of a patient who presented with unilateral panuveitis following a relapsing febrile illness and in whom B. persica DNA was detected in vitreous fluid, emphasizing the diagnostic challenges, microbiologic findings, and therapeutic outcome. Methods Observational case report. Results A previously healthy 20-year-old man presented with a one-week history of right eye floaters, redness, pain, and photophobia, preceded by a month of recurrent febrile episodes initially attributed to gastroenteritis. Best-corrected visual acuity was hand motion. He had non-granulomatous panuveitis with dense vitritis, optic disc edema, and retinal periphlebitis. Systemic infectious and autoimmune evaluation was unremarkable. Despite high-dose systemic corticosteroid therapy, vitritis remained marked, prompting diagnostic vitrectomy. Broad-range bacterial 16 S rRNA gene polymerase chain reaction (PCR) of undiluted vitreous identified B. persica . Following combined management with vitrectomy, oral doxycycline 100 mg twice daily for 14 days, and a gradual corticosteroid taper, intraocular inflammation resolved and visual acuity recovered to 20/25, with no recurrence during three months of follow-up. Conclusions To our knowledge, this is the first report of species-level molecular detection of B. persica in intraocular fluid. Detection of B. persica DNA in vitreous fluid supports B. persica –associated intraocular infection, although PCR does not establish the presence of viable organisms, and hematogenous dissemination to the eye can be neither confirmed nor excluded. In endemic regions, a recent relapsing febrile illness in a patient with severe panuveitis should prompt early consideration of tick-borne relapsing fever and intraocular fluid sampling, preferably before escalation of systemic immunosuppression.