Acute, Posterior, Multifocal, Placoid, Pigment Epitheliopathy and Lyme Disease

To the Editor.  —Acute, posterior, multifocal, placoid, pigment epitheliopathy (APMPPE) is an idiopathic chorioretinal inflammatory disease. Because a prodromal upper respiratory illness may frequently occur, a viral or other infectious etiology has been postulated. We recently reported a case of a woman with APMPPE whose mother and brother developed optic neuritis within 3 months of each other.¹ We have noticed that APMPPE cases appear to occur in clusters. A previous report has suggested a possible association between an APMPPE-like chorioretinal inflammation and Lyme disease.²Lyme disease is a multisystem disorder caused by the tick-borne spirochete, Borrelia burgdorferi. This disease can cause a variety of ocular inflammations, including conjunctivitis, episcleritis, stromal keratitis, iridocyclitis, pars planitis, choroiditis, vitritis, and optic neuritis. Borrelia burgdorferi has been identified histopathologically in the retina and vitreous.³ We evaluated serum from a group of patients with APMPPE for evidence of antibodies directed against B