Peripheral neuropathy due to neuroborreliosis: Insensitivity for CXCL13 as early diagnostic marker

Abstract

The case of a 69-year-old woman with peripheral neuropathy caused by Lyme neuroborreliosis (LNB) in an endemic region in Eastern Austria is reported. The patient had noticed transient numbness of her left leg. On initial examination, she had patchy sensory disturbances of the left lower leg, but ancillary examinations of nerve conduction and cerebrospinal fluid (CSF), including the B-cell chemokine CXCL13, were normal. A re-tap performed 54 days later, following clinical progression with foot drop, widespread lower leg paresthesia, and pain, revealed an increased cell count, autochthonous IgM production, synthesis of Borrelia-specific IgM, and elevated CXCL13. Neurophysiological examinations disclosed an incomplete conduction block, mixed axonal and demyelinating sensorimotor neuropathy, and subacute neurogenic damage of muscles innervated by the peroneal nerve. This case study presents rare evidence of very early diagnostic findings in peripheral neuropathy caused by LNB. These are characterized by insensitivity of CXCL13 in CSF to aid earlier diagnosis and the development of an intrathecal immune response against Borrelia at a later stage. These findings reinforce the need for a re-tap to confirm the diagnosis and facilitate appropriate treatment in this rare manifestation of LNB.

Supplement Section Varia

“…The determination of the concentration of the chemokine CXCL13 in the CSF ELISA test was done in the Department of Microbiology of the UKC RS, the euroimmune test CXCL13 ELISA was used and the findings were mostly negative and did not help in the diagnosis as well as RT PCR. Also in the literature, patients with definite LNB have been reported to have negative CXCL13 [22,23]. CSF testing, including CXCL13, may be important for central nervous system Lyme disease, but not for peripheral nervous system where CXCL13 insensitivity has been detected in the cerebrospinal fluid.…”

“…CSF testing, including CXCL13, may be important for central nervous system Lyme disease, but not for peripheral nervous system where CXCL13 insensitivity has been detected in the cerebrospinal fluid. The concentration of CXCL13 in the cerebrospinal fluid is generally normal in Lyme encephalopathy as well [23,24]. Other studies report that in early disseminated and late neurological manifestations of LNB, PCR in CSF is often negative and of limited value due to the small number of bacteria in these types of samples [86].…”

Supplement Section Medicine

“…The determination of the concentration of the chemokine CXCL13 in the CSF ELISA test was done in the Department of Microbiology of the UKC RS, the euroimmune test CXCL13 ELISA was used and the findings were mostly negative and did not help in the diagnosis as well as RT PCR. Also in the literature, patients with definite LNB have been reported to have negative CXCL13 [22,23]. CSF testing, including CXCL13, may be important for central nervous system Lyme disease, but not for peripheral nervous system where CXCL13 insensitivity has been detected in the cerebrospinal fluid.…”

“…CSF testing, including CXCL13, may be important for central nervous system Lyme disease, but not for peripheral nervous system where CXCL13 insensitivity has been detected in the cerebrospinal fluid. The concentration of CXCL13 in the cerebrospinal fluid is generally normal in Lyme encephalopathy as well [23,24]. Other studies report that in early disseminated and late neurological manifestations of LNB, PCR in CSF is often negative and of limited value due to the small number of bacteria in these types of samples [86].…”

Untitled

“…The determination of the concentration of the chemokine CXCL13 in the CSF ELISA test was done in the Department of Microbiology of the UKC RS, the euroimmune test CXCL13 ELISA was used and the findings were mostly negative and did not help in the diagnosis as well as RT PCR. Also in the literature, patients with definite LNB have been reported to have negative CXCL13 [22,23]. CSF testing, including CXCL13, may be important for central nervous system Lyme disease, but not for peripheral nervous system where CXCL13 insensitivity has been detected in the cerebrospinal fluid.…”