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Presentation type	E-poster
Title	Inaugural sixth nerve palsy in a patient with neuroborreliosis: a case report

Purpose	Sixth cranial nerve palsy is the most common type of ocular motor nerve palsy. There are various etiologies including neoplastic, traumatic, infectious, microvascular diseases and giant cell arteritis. Some of these causes are fatal and require further neurological treatment. We report an uncommon presentation of Lyme disease and illustrate the importance of a detailed history in a patient with inaugural sixth nerve palsy.
Methods	A 46-year-old man presented to the ophthalmology emergency department with horizontal diplopia and holocranial headaches radiating to the cervical level. Ophthalmologic examination revealed a left sixth cranial nerve palsy. Primary workup including general biology and MRI were unremarkable except for positive Borrelia serum IgG antibodies. Two weeks later at the follow-up appointment, the patient complained about a peripheral facial palsy on the left side with an increase of headache and diplopia. Further history-taking revealed an episode of tick-biting four months ago. Cerebrospinal fluid Lyme antibodies came back positive.
Results	A neuroborreliosis defined as a neurologic involvement secondary to systemic infection by the spirochete Borrelia Burgdoferi, was diagnosed. The patient was treated with oral Doxycycline 100mg b.i.d for 28 days. At the end of the treatment, the patient was free of symptoms.
Conclusion	This case illustrates that a detailed history and a follow-up is warranted in atypical cases associated with red flags. Lyme disease can present through different ocular manifestations. Therefore, ophthalmologists can have an important role in the diagnosis of this disease
Conflict of interest	No

Authors 1

Last name	LAHRICHI
Initials	Y
Department	Ophtalmology
City	Liege

Authors 2

Last name	CHAPELLE
Initials	A-C
Department	Ophtalmology
City	Liege

Authors 3

Last name	RAKIC
Initials	J-M
Department	Ophtalmology
City	Liege