Neuroborreliosis Presenting as Acute Disseminated Encephalomyelitis

Rocha, Ruben; Lisboa, Lurdes; Neves, João Farela; López, Milagros García; Santos, Elsa; Ribeiro, Augusto

doi:10.1097/pec.0b013e318276c51d

Cited by 12 publications

(7 citation statements)

References 10 publications

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“…Rocha et al [35] reported a child neuroborreliosis presenting as ADEM and confirmed by PCR method in CSF. However, in our two patients with ADEM diagnosis and LNB DNA Borrelia was not found in CSF, but IgG, IgM antibodies were detected in CSF and serum.…”

Section: Discussionmentioning

confidence: 88%

Lyme Neuroborreliosis (LNB) – Clinical and Diagnostic Difficulties

Dunin-Wąsowicz¹,

Kasztelewicz²,

Tomaszek³

et al. 2017

Child Neurology

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Tickborne spirochaetes of the Borrelia burgdroferi sensu lato genospecies cause Lyme disease. For many years Lyme neuroborreliosis (LNB) has been known as a frequent (14%-34% or 40%) manifestation of Lyme disease [1,2]. Symptoms of LNB are not characteristic and typical for LNB only but may often mimic other neurological diseases. Diagnosis of LNB is based on clinical presentation of different neuro- STRESzCzENIECel: Zastosowanie metody RT-PCR dla wykrywania DNA Borrelia burgdorferi w płynie mózgowo-rdzeniowym u pacjentów pediatrycznych z różnymi objawami neurologicznymi i podejrzeniem choroby z Lyme. Materiał i metody: Badanie prospektywne przeprowadzono u 107 dzieci w wieku od 1-18 lat (średnio 12.2 lat). Badania serologiczne we krwi przeprowadzano dwuetapowo -test ELISA, a następnie test Western blot. W próbkach płynu mózgowo-rdzeniowego wykonywano test ELISA oraz badanie metodą RT-PCR celem potwierdzenia lub wykluczenia rozpoznania neuroboreliozy (LNB). U wszystkich pacjentów wykonywano badania neurologiczne, okulistyczne i neuroobrazowe. Wyniki: U 60 (56.1%) dzieci stwierdzono dodatnie wyniki przeciwciał IgG i/lub IgM w surowicy i/lub w płynie mózgowo-rdzeniowym. Tylko u 2/60 (3.3%) wykryto DNA Borrelia burgdorferi PMRDz oraz specyficzne przeciwciała w surowicy i w płynie mózgowo-rdzeniowym (przypadki LNB -aseptyczne zapalenie opon mózgowo-rdzeniowych z TIA oraz zapalenie nerwu II I nerwu VI). LNB zdiagnozowano u 33 pacjentów a u 22/107 (20.5%) rozpoznano choroby demielinizacyjne. U dzieci z LNB stwierdzono statystycznie znamiennie wyższe miana IgG w PMRDz i wyniki testu Western blot -IgG p (chi2 >9.333)=0.0023, WB-p (chi2>12.941)=0.0003. Wnioski: Wykrycie DNA Borrelia burgdorferi w PMRDz przy użyciu metody RT-PCR może być pomocne dla potwierdzenia diagnozy wczesnej LNB. Negatywne wyniki DNA Borrelia burgdorferi w PMRDz są szczególnie ważne dla wykluczenia LNB i przydatne dla ustalenia rozpoznania chorób demielinizacyjnych. Kuracja Ceftraksonem podawanym dożylnie przez 4 tygodnie jest skuteczna w leczeniu neuroinfekcji, eliminacji DNA Borrelia burgdorferi z płynu mózgowo-rdzeniowego i poprawy klinicznej pacjentów.

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Section: Discussionmentioning

confidence: 88%

Lyme Neuroborreliosis (LNB) – Clinical and Diagnostic Difficulties

Dunin-Wąsowicz¹,

Kasztelewicz²,

Tomaszek³

et al. 2017

Child Neurology

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Section: Discussionmentioning

confidence: 98%

“…Although several previous reports have documented respiratory failure in patients with ADEM exhibiting unilateral medullary lesions, no reports have documented the occurrence of concurrent bilateral medullary lesions in such patients. [1][2][3][4][5] Francis et al 5 reported that two patients who had developed ADEM following M. pneumoniae infection exhibited no improvement, although these patients underwent artificial respiration only and were not treated using anti-inflammatory and immunosuppressive drugs. Our patient experienced severe symptoms including respiratory arrest, impaired consciousness, and tetraplegia; however, his clinical symptoms improved remarkably following immunotherapy.…”

Section: Discussionmentioning

confidence: 99%

Acute disseminated encephalomyelitis following Mycoplasma pneumoniae infection complicated by respiratory arrest due to concurrent bilateral lateral medullary lesions: A case report

Fukuoka

Nakazato

Kawasaki

et al. 2018

Neurology & Clinical Neurosc

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Reports on concurrent bilateral lateral medullary lesions in patients with neurological disorders are lacking. Herein, we discuss the case of a 40‐year‐old man who developed acute disseminated encephalomyelitis due to Mycoplasma pneumoniae infection. Brain magnetic resonance imaging revealed high signal intensities and demyelination in the concurrent bilateral lateral medulla and cervical spinal cord. Clinical features included respiratory arrest and psychiatric symptoms, although his symptoms improved several months following the initiation of artificial respiration and repeated steroid pulse therapy. Such findings emphasize the need to carefully monitor patients with acute disseminated encephalomyelitis exhibiting concurrent bilateral medullary lesions due to the risk of sudden respiratory arrest.

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“…Vitamin B 12 deficiency and autoimmune conditions such as systemic lupus erythematosus are important to consider, as well as the rare but frequently missed acute disseminated encephalomyelitis. 5 …”

Section: Discussionmentioning

confidence: 99%

A case of chronic progressive Lyme encephalitis as a manifestation of late Lyme neuroborreliosis

Verma

Roman

Shah

et al. 2014

Infectious Disease Reports

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A 54-year-old female living in Europe presented with gait ataxia, dizziness, and bilateral hearing loss. Magnetic resonance imaging (MRI) revealed non-specific white matter changes. The patient’s condition gradually deteriorated over two years without diagnosis. The patient continued to decline cognitively and neurologically with worsening ataxia and upper motor neuron signs. Repeat MRI showed worsening white matter changes. Lumbar puncture, not previously done, showed positive Lyme testing. Treatment with intravenous ceftriaxone resulted in marked neurological improvement. Four years after symptom, the patient has short-term memory deficits and chronic fatigue, but is otherwise neurologically, cognitively, and functionally intact. Follow up MRI findings remain largely unchanged. Because cases of intraparenchymal or encephalopathic neuroborreliosis in America are lacking, so are treatment options. We present a rare case and discuss our experience with antibiotic treatment. This case lends evidence to define optimal treatment of this disease, imperative for hastening neurological recovery.

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Neuroborreliosis Presenting as Acute Disseminated Encephalomyelitis

Cited by 12 publications

References 10 publications

Lyme Neuroborreliosis (LNB) – Clinical and Diagnostic Difficulties

Lyme Neuroborreliosis (LNB) – Clinical and Diagnostic Difficulties

Acute disseminated encephalomyelitis following Mycoplasma pneumoniae infection complicated by respiratory arrest due to concurrent bilateral lateral medullary lesions: A case report

A case of chronic progressive Lyme encephalitis as a manifestation of late Lyme neuroborreliosis

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