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A significant B. burgdorferi seroconversion with an IgM of 1:80 was observed in a patient complaining of loss of vision in his right eye. The finding correlated morphologically with hyperpigmentation and depigmentation in the macular region, similar to pigment epitheliitis or choriocapillaritis. In the course of the following four weeks the IgM decreased by four titer steps. The visual acuity of the patient’s right eye recovered from 0.4 on admission to 1.0 on discharge. The angiogram did not reveal any pathology. Since choroidal manifestations have often been documented in patients with B. burgdorferi infections, it is recommended that serological workups be performed in such patients. Studies in larger groups of patients are necessary to establish the relevance of this case report and its significance concerning infection as a cause of choriocapillaritis.