Opsoclonus-myoclonus as a manifestation of Lyme disease

Abstract

Opsoclonus-myoclonus syndrome (OMS) is a rare condition that includes chaotic multidirectional saccadic eye movements associated with myoclonus and ataxia. In adults, it is usually considered to be an autoimmune disease occurring either in a paraneoplastic context or after central nervous system infection. We report the case of a patient who presented with the classic features of OMS as a manifestation of acute Borrelia burgdorferi infection that was shown both on serum and cerebrospinal fluid examination. The outcome was favourable after prolonged antibiotic treatment. Lyme disease could be added to the list of aetiologies to be screened in OMS, as it would allow effective treatment and avoidance of unnecessary investigations.

Adult-onset opsoclonus-myoclonus-ataxia syndrome as a manifestation of brazilian lyme disease-like syndrome: a case report and review of literature

“…Higher cell counts do not rule out idiopathic or paraneoplastic causes, but should raise the suspicion of an isolated or associated infection as observed in our patient. In four previously reported patients with Borrelia-associated OMAS, the cell counts ranged from 28 to 244 cells/mm 3 and the remaining CSF characteristics were very similar to our case 34 - 37…”

“…Parainfectious causes may be diverse and include agents such as cytomegalovirus, EBV, Coxsackie virus, West Nile virus, HIV, varicella-zoster virus, Influenza A virus, hepatitis C virus, Mycoplama pneumoniae , Salmonella sp., Ricketsia, group A streptococci, mumps, Lyme Disease (LD), and psittacosis 2 , 10 , 14 , 17 , 34 , 36 , 49 - 59. OMAS was also described after measles, mumps, and rubella vaccine 60.…”

Ocular motor syndromes of the brainstem and cerebellum

“…Lyme disease should be also added to the list of etiologies to be screened in OMS [47]. Finally, a case of bidirectional ocular flutter, specifically induced by OKN, was reported in a patient presenting with an olivo-ponto-cerebellar atrophy [48].…”

Opsoclonus-Myoclonus Syndrome Following Influenza A Infection

“…In cases of paraneoplastic OMS, small cell lung cancer, breast cancer, and ovarian cancer were most commonly encountered in adults (10), whereas more than half of these cases were associated with neuroblastoma in children (11,12). In OMS with a confirmed infectious agent, psittacosis (10,13), Mycoplasma infection (14), Salmonella infection (10,15,16), group A streptococcal infection (17), neuroborreliosis (18,19), Rickettsia infection (10), St. Louis encephalitis (10,20), coxsackievirus (10), enterovirus 71 (21), cytomegalovirus (22), Epstein-Barr virus (23), human immunodeficiency virus (24), and hepatitis C virus (25) have been described as the causative agents. Although the case of a 30-year-old woman with OMS 15 days after anti-rubella vaccination has been reported (26), seasonal influenza vaccination-related OMS has not yet been reported.…”