Abstract Details

Title Lyme Neuroborreliosis Initially Presenting as a Cavernous Sinus Syndrome: A Case Report

Topic Infectious Disease

Presentation(s) P5 - Poster Session 5 (5:30 PM-6:30 PM)

Poster/Presentation
Number 4-016

Objective We describe a patient with Lyme neuroborreliosis (LNB) who presented with clinical and radiographic findings initially suggestive of cavernous sinus syndrome.

Background Lyme disease is a tick-borne illness of increasing incidence in the United States. Nervous system involvement, or LNB, can present with lymphocytic meningitis and cranial neuropathies, with the seventh cranial nerve most commonly affected.

Design/Methods NA

Results A 73-year-old man presented with one week of right eye pain and swelling, blurry vision, diplopia, and headache. He noted in the history that four weeks prior he removed a tick from his skin and had developed a transient fever and an erythematous abdominal rash around that time. Examination demonstrated a right CN VI palsy, mild right ptosis, and decreased vision in the right eye. MRI brain revealed infiltrative enhancement involving the right cavernous sinus, Meckel’s cave, CN V, and orbit. The broad differential of cavernous sinus syndrome was entertained, with further concern for LNB given the history. Lumbar puncture revealed a lymphocytic pleocytosis. On hospital day 6, the patient developed a right CN VII palsy. Acute Lyme infection was confirmed with western blot. The patient completed a 14-day course of ceftriaxone. At follow-up four weeks later, he reported resolution of symptoms. Repeat MRI brain demonstrated interval improvement, except for more conspicuous enhancement along the right facial nerve.

Conclusions This patient initially presented with clinical and radiographic findings concerning for an infiltrative or inflammatory process of the cavernous sinus. A wide differential was considered, including Tolosa-Hunt syndrome, lymphoma, sarcoidosis, vascular etiologies, and other infectious/inflammatory conditions. The clinical history was suspicious for LNB and the diagnosis was confirmed. The patient was treated accordingly and had a robust clinical response. This case report highlights a rare presentation of LNB and reviews the broad differential of cavernous sinus syndrome.

Authors/Disclosures
Hannah N. Rinehardt PRESENTER	No disclosure on file
Benjamin Jiang, MD	Dr. Jiang has nothing to disclose.
	No disclosure on file
Chad Hoyle, MD (Ohio State University)	Dr. Hoyle has received personal compensation in the range of $100,000-$499,999 for serving as a Consultant for National Football League. Dr. Hoyle has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Avexis. Dr. Hoyle has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Reata. The institution of Dr. Hoyle has received research support from REATA. The institution of Dr. Hoyle has received research support from TAKEDA.

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