Lyme Disease?-Reply

In Reply. —Dr Winterkorn objects to our association of branch retinal artery occlusion and Lyme disease on two premises: (1) the serologic evidence supports a diagnosis of syphilis and not Lyme disease, and (2) even if our patient had Lyme disease, the artery occlusion was merely a coincidence and not causally related. For the following reasons we believe both objections are unfounded. The serologic diagnosis of Lyme disease is a well-recognized quagmire because of the cross-reactivity of Lyme sera with serologic tests for other spirochetal diseases, including syphilis. Conversely, sera from patients with syphilis can cross-react with the serologic tests for Lyme disease. 1,2 Whether or not syphilis is the most common cause of positive Lyme serologic test results in Miami, Fla, is irrelevant since Lyme disease is inarguably a common cause of positive Lyme serologic tests results. Winterkorn asserts without substantiating references that "Lyme disease itself does not produce