Holmes-Adie syndrome and Lyme disease, The Lancet, 10 March 2001
Art Doherty
The Lancet, Volume 357, Number 9258, 10 March 2001
Correspondence
Holmes-Adie syndrome and Lyme disease
Sir--Paolo Martinelli (Nov 18, p 1760
http://www.thelancet.com/journal/vol357/iss9258/full/llan.356.9243.editorial_and_review.14200.1
)1 provides an excellent clinical and
historical overview of Holmes-Adie syndrome (tonic pupil and areflexia),
more commonly known in the USA as Adie syndrome. Although the
syndrome has not been associated with "infection of conventional
bacterial or viral origin", it is occasionally linked to early syphilis,
parvovirus B19, and herpes simplex virus infections.2-4 We now report
an association with neurological Lyme disease.
In a referral practice of about 140 patients with Lyme disease, we have
seen three patients with predominant neurological symptoms who
presented with Holmes-Adie syndrome (table). The diagnosis of Lyme
disease was based on a history of tickbite, presence of an erythema
migrans rash and positive serology for the spirochaete Borrelia
burgdorferi. The duration of Lyme disease symptoms ranged from 2-16
years, and each patient developed a unilateral tonic pupil before the
diagnosis of Lyme disease was made. All three patients had significant
neuropsychiatric and cognitive defects, hyporeflexia, and facial
dysaesthesia without anhydrosis. Rapid plasma reagin testing was
negative in each case. Two patients had abnormal brain magnetic
resonance imaging with white-matter lesions consistent with neurological
Lyme disease. A decreased concentration of CD57 lymphocytes
characteristic of chronic Lyme disease5 was found in two patients before
antibiotic therapy. Of note, Holmes-Adie syndrome persisted in each
case despite intravenous antibiotic therapy and partial resolution of
other neurological symptoms of Lyme disease.
Patient Age/sex Duration Topic CD57 Brain Antibiotic
of Lyme pupil (cells/µL) MRI treatment
disease
(years)
------- ------- -------- ---------- ---------- -----
----------
1 39 F 16 Unilateral 49* Negative IV
2 42 F 8 Unilateral 31* Positive IV
3 39 F 2 Unilateral 111† Positive IV
MRI=magnetic resonance imaging; IV=intravenous ceftriaxone. *Before
antibiotics. †On antibiotics. Normal CD57 range 60-360 cells/µL.
Characteristics of patients with Lyme disease and Holmes-Adie
syndrome
Neurological Lyme disease has been associated with various cranial
nerve, meningeal, and neuropsychiatric abnormalities.5 Based on our
clinical observation, it seems that Holmes-Adie syndrome might
represent an early and unrecognised manifestation of Lyme disease.
We suggest that patients presenting with this unusual
neuro-ophthalmological syndrome should be tested for the Lyme
disease spirochaete.
*Raphael B Stricker, Edward E Winger
*California Pacific Medical Center, San Francisco, CA 94120,
USA; and Immunodiagnostic Laboratories, San Leandro, CA,
USA
1 Martinelli P. Holmes-Adie syndrome.
Lancet 2000; 356: 1760-61. [Text]
2 Yasaki S, Ohshima J, Yonekura J, TakahashY, Someya K. A case
of early syphilis presenting general paresis-like symptoms and bilateral
tonic pupils. Rinsho Shinkeigaku 1992; 32: 994-99. [PubMed]
3 Corridan PG, Laws DE, Morrell AJ, Murray PI. Tonic pupils and
human parvovirus (B19) infection. J Clin Neuroophthalmol
1991; 11: 109-10. [PubMed]
4 Anzai T, Uematsu D, Takahashi K, Katayama T. Guillain-Barre
syndrome with bilateral tonic pupils. Intern Med
1994; 33: 248-51. [PubMed]
5 Stricker RB, Winger EE. Decreased CD57 lymphocyte subset in
patients with chronic Lyme disease. Immunol Lett (in press).
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Holmes-Adie syndrome and Lyme disease,
The Lancet, Volume 357, Number 9258, 10 March 2001
http://www.thelancet.com/journal/vol357/iss9258/full/llan.357.9258.correspondence.15500.1
The Journal : Current Issue
http://www.thelancet.com/journal
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MOnkeys04
AramSarah
others too.
Art Doherty
Handbook of Ocular Disease Management - Tonic Pupil
http://www.revoptom.com/handbook/sect6k.htm
Art D.
Dave and Lisa Schwarz
> Dave and Lisa Schwarz wrote:
> >
> > WOW ‹ I had this. It scared me so bad that it was the one question I've
> > never brought up to a doctor ‹ because I was afraid of what they'd tell
> > me. Good to know it's just another Lyme thing.
>
> good to know you have a mere brain infection
> LOL
Yep. Strange how you perspective changes with this, ain't it?
Lisa
Dave and Lisa Schwarz
never brought up to a doctor ‹ because I was afraid of what they'd tell
me. Good to know it's just another Lyme thing.
Lisa (MN)
In article <20010313095447...@ng-cr1.news.cs.com>,
Phyllis Mervine
Dave and Lisa Schwarz wrote:
>
> WOW ‹ I had this. It scared me so bad that it was the one question I've
> never brought up to a doctor ‹ because I was afraid of what they'd tell
> me. Good to know it's just another Lyme thing.
good to know you have a mere brain infection
LOL