Abstract Details

Title Acute Lyme Neuroborreliosis (LNB) Presenting as Painful Lumbosacral Myeloradiculopathy

Topic Infections/AIDS/Prion Disease

Presentation(s) P06 - (-)

Poster/Presentation
Number 191

Objective

Background BACKGROUND: LNB may appear during early or late-stage systemic involvement. Prompt clinical diagnosis and treatment reduces long-term morbidity. Early systemic inflammatory and immunological markers are unpredictable and misleading. Authors describe clinical presentation, diagnosis, and treatment of early-disseminated Lyme disease with neurological involvement.

Design/Methods DESIGN/METHODS: A 46-year-old patient presented with new onset right facial weakness. Patient had presented with painful lumbosacral myeloradiculopathic symptoms, fever, neck pain, 7-cm-oval-erythematous lesion in right groin 10 days earlier and was receiving prednisone. Patient was afebrile without skin lesions, reported tick removal 2 years prior but not recently. Examination was remarkable for right Bell's palsy and hyperreflexia without limb weakness or sphincter involvement. MRI-brain was normal, MRI-spine showed T2-hyperintensity within spinal cord extending from T-8 to conus medullaris without abnormal enhancement. Diagnostic spinal-tap revealed lymphocytic pleocytosis (WBC: 491), high protein (183), IgG index (0.99), >5 well-defined ?-restriction bands; negative Lyme disease DNA PCR, viral, fungal, and bacterial studies, and normal angiotensin converting enzyme levels. NMO antibodies were negative. Lyme disease serology showed positive IgG and IgM antibodies with IgM antibody index of 7.21 and IgG/IgM antibody index of 12.0.

Results RESULTS: Diagnosis of acute LNB was considered, patient was given 2-gram intravenous ceftriaxone daily for 28-days, which resolved symptoms. Neurological examination normalized by the end of therapy.

Conclusions CONCLUSIONS: Though there were no Lyme DNA or antibodies identified in CSF, negative-history of prior neuroborreliosis, positive serum anti-Borrelia antibody index and absence of other etiological explanations for symptoms but a favorable outcome after antibiotic treatment confirmed that the patient had LNB. Unpredictable inflammatory and immunological response to B. burgdorferi makes a quick and practical bedside diagnosis and management of neuroborreliosis difficult for clinicians: controversies exist despite top quality clinical research in this field. This case report illustrates a clinician's approach towards the management of acute neuroborreliosis.

Authors/Disclosures
Tara Kimbason, MD, MPH (Parkview Neurology) PRESENTER	No disclosure on file
Sanjay Mittal, MD (Geisinger Medical Center)	Dr. Mittal has nothing to disclose.
Roy L. Freeman, MD (Beth Israel Deaconess Hosp)	Dr. Freeman has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Cutaneous Diagnostic Life Sciences. Dr. Freeman has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Vertex. Dr. Freeman has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Theravance. Dr. Freeman has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for Inhibikase. Dr. Freeman has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier. The institution of Dr. Freeman has received research support from NIH. The institution of Dr. Freeman has received research support from Theravance. The institution of Dr. Freeman has received research support from Biohaven. The institution of Dr. Freeman has received research support from Lundbeck. Dr. Freeman has received research support from Regeneron.

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