Misleading presentation of acute Lyme neuroborreliosis

Winter, Elizabeth M.; Rothbarth, P. H.; Delfos, Nathalie M

doi:10.1136/bcr-2012-006840

Cited by 4 publications

(1 citation statement)

References 17 publications

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“…Erythema migrans cannot be relied upon in the diagnosis of LD; it is absent in approximately 20-30% of cases 7,8 and uncommon in BS. 9 As a result, patients may not seek medical attention until the more debilitating manifestations of later disease are apparent. 7 The challenge for physicians is early recognition of LD, even in the absence of EM.…”

Section: Discussionmentioning

confidence: 99%

An Unusual Presentation of Lyme Neuroborreliosis

Kitto¹,

McKenna²

2015

Acute Med

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Back pain is a common symptom among patients presenting to the acute medical unit. We describe the case of a 55-year-old man with a brief history of fatigue and severe back pain, unresponsive to escalating doses of opiate analgesia. Blood tests and imaging studies were unremarkable and a functional diagnosis was considered. Several weeks into his admission he developed a lower motor neurone facial nerve palsy. He was treated with antibiotics for an incidental finding of a hospital-acquired pneumonia on imaging, which remarkably led to the resolution of his facial palsy and allowed a dramatic reduction in analgesia. This triggered further investigations; identifying Lyme neuroborreliosis as the cause of his symptoms.

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Section: Discussionmentioning

confidence: 99%

An Unusual Presentation of Lyme Neuroborreliosis

Kitto¹,

McKenna²

2015

Acute Med

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Secondary dementia due to Lyme neuroborreliosis

Kristoferitsch

Aboulenein-Djamshidian

Jecel

et al. 2018

Wien Klin Wochenschr

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SummaryDementia-like syndromes are rare manifestations of Lyme neuroborreliosis. The clinical patterns are summarized using our own cases and case reports from the literature, which were diagnosed as definite Lyme neuroborreliosis according to the European guidelines. The cases disclose signs of subcortical dementia that occur more rapidly than in patients suffering from primary dementia. Gait disturbances early in the disease course is another frequently observed characteristic feature. The response to 2–4 weeks of antibiotic treatment with ceftriaxone was excellent. There were no indications for a prolonged antibiotic treatment. It is essential to be aware of this manifestation of Lyme neuroborreliosis, because early antibiotic treatment will prevent permanent sequelae that may occur throughout the further course of the untreated disease.

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A Case of Early Disseminated Neurological Lyme Disease Followed by Atypical Cutaneous Manifestations

Kantamaneni

Sunder

Bilal

et al. 2017

Case Reports in Infectious Diseases

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Lyme disease (LD) is a tick-borne illness caused by Borrelia burgdorferi sensu stricto. An 80-year-old female from Pennsylvania, USA, presented to an outside hospital with fever, confusion, lower extremity weakness, and stool incontinence. CT head and MRI spine were unremarkable. An infectious work-up including lumbar puncture was negative. She was transferred to our tertiary care hospital. Patient was noted to have mild unilateral right-sided facial droop and a diffuse macular rash throughout the body. She denied any outdoor activities, tick bites, or previous rash. Intravenous ceftriaxone was started for suspected LD. The patient's symptoms including facial droop resolved within 24 hours of antibiotic therapy. Polymerase chain reaction of the blood, IgM ELISA, and IgM Western blot testing for LD came back positive a few days after initiation of therapy. She was treated for a total of 21 days for neurological LD with complete symptom resolution. Not all patients have the classic “targetoid” EM rash on initial presentation, rash could develop after neurological manifestations, and prompt initiation of antibiotics without awaiting serology is paramount to making a quick and a full recovery. There should be a high index of suspicion for early disseminated LD, as presentations can be atypical.

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Misleading presentation of acute Lyme neuroborreliosis

Cited by 4 publications

References 17 publications

An Unusual Presentation of Lyme Neuroborreliosis

An Unusual Presentation of Lyme Neuroborreliosis

Secondary dementia due to Lyme neuroborreliosis

A Case of Early Disseminated Neurological Lyme Disease Followed by Atypical Cutaneous Manifestations

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