Abstract Details

Title Lyme Neuroborreliosis Presenting with a Cytotoxic Lesion of the Corpus Callosum, Diffuse Cerebral Edema, and Multifocal Infarcts

Topic Infectious Disease

Presentation(s) P13 - Poster Session 13 (5:30 PM-6:30 PM)

Poster/Presentation
Number 13-003

Objective We describe a patient with Lyme neuroborreliosis who presented with encephalopathy and signs of elevated intracranial pressure. Imaging demonstrated diffuse cerebral edema and diffusion restriction in the corpus callosum and bilateral centrum semiovale.

Background Lyme disease is a tick-borne illness caused by the spirochete Borrelia burgdorferi. Nervous system involvement, or lyme neuroborreliosis (LNB), can present with meningoencephalitis, cranial neuropathy, polyradiculitis, myelopathy, or cerebral vasculitis. Callosal lesions are not typically seen but have been reported in the literature.

Design/Methods N/A

Results A 19-year-old male developed progressively worsening headache and vomiting for 2 weeks. He became febrile to 101.3 °F and encephalopathic prior to presenting for evaluation. CT of the head demonstrated diffuse cerebral edema. CSF analysis showed a lymphocytic pleocytosis of 355 WBC/μL and elevated protein of 85 mg/dL. He recalled removing a tick attached to his neck 51 days prior to symptom onset. Initial serum lyme antibody testing on presentation was negative. MRI brain on presentation showed a small focus of diffusion restriction in the right centrum semiovale as well as diffuse leptomeningeal enhancement. MRI brain on hospital day 10 showed new areas of diffusion restriction in the splenium of the corpus callosum and left centrum semiovale. Repeat serum lyme antibody testing on hospital day 13 was positive. Confirmatory western blot was inconclusive but B. burgdorferi C6 peptide was positive. The patient was treated with a 28-day course of ceftriaxone and critical supportive care. He suffered significant vision loss secondary to prolonged bilateral papilledema from elevated ICP, but otherwise made a good recovery.

Conclusions Lyme disease can have a widely variable neurological presentation, making diagnosis challenging at times. We present an atypical case of LNB illustrating that a high index of suspicion should be maintained in cases of undifferentiated meningoencephalitis and repeating lyme serology should be considered when supported by a strong clinical history.

Authors/Disclosures
Benjamin Jiang, MD PRESENTER	Dr. Jiang has nothing to disclose.
Appaji Rayi, MD, FAAN (Charleston Area Medical Center)	Dr. Rayi has nothing to disclose.

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