Lyme disease case studies 
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 Lyme disease case studies

Dtsch Med Wochenschr ? Volume 110 ? Issue 26

[Progressive Borrelia encephalomyelitis. Chronic manifestation of erythema
chronicum migrans disease of the nervous system]
Ackermann R, Gollmer E, Rehse-Kpper B
Dtsch Med Wochenschr 1985 Jun 28 110:26 1039-42

A 54-year-old housewife became ill with transient diplopia followed by
{*filter*} paralysis, tremor of the right hand and a progressively worsening
disturbance in gait. Four years after the first appearance of the disease
bilateral hypacusia, paralysis of the right hypoglossal nerve, dysarthria,
severe spastic tetraparesis with ataxia, urinary retention and an
organically induced character change were present. Lumbar puncture fluid
contained 51/mm3 lymphocytes and 1164 mg/dl protein. Immunoglobulin A, G and
M, synthesised locally, could be detected in cisternal fluid. The serum had
a high antibody titre against Ixodes ricinus-Borrelia antigen and the same
antibodies, formed locally, were present in the lumbar fluid. The
neurological deficiencies improved markedly under parenteral penicillin
treatment and the antibody titre decreased. The detection of Borrelian
antibodies, especially those synthesised locally in the CSF, enabled an
aetiological diagnosis to be made in seven other patients aged 18-47 years
in whom the disease had been present for 1 to 8 years. These patients
likewise presented symptoms characteristic of a disseminated disease of the
CNS, with spastic pareses and evidence in the spinal fluid of chronic
inflammation and disruption of CSF barriers in particular. This progressive
encephalomyelitis differs from the common and spontaneously healing
meningo-polyneuritis (Garin-Bujadoux-Bannworth), the usual manifestation of
erythema chronicum migrans of the nervous system, in its progressive nature,
its invasion of the CNS and the possible long lasting severe damage when not
specifically treated.

Adolescence, {*filter*}, Antibodies, Bacterial, Borrelia, Borrelia Infections,
Case Report, Cerebrospinal Fluid, Encephalomyelitis, English Abstract,
Erythema, Female, Human, Immunoglobulins, Immunosuppressive Agents, Male,
Middle Age, Muscle Spasticity, Penicillins
neuroborreliosis: a case study.
Piccolo, I., Thiella, G., Sterzi, R., Colombo, N., Defanti, C. A.
Italian Journal of Neurological Sciences 1998,  235-239

Country: Italy
Abstract journal details: 0J08710
Language: En
Other info: 21 ref.
Authors affiliation: Division of Neurology, Hospital Niguarda Ca' Granda,
Piazza Ospedale Maggiore 3, I-20162 Milan, Italy.

A 45-year-old woman was seen in hospital in Milan, Italy, on 28 June 1996
following the onset of behavioural disturbances and confusional episodes
over the period of a month, and the subsequent appearance of involuntary
choreia movements. On analysis of cerebrospinal fluid, anti-Borrelia
antibodies were discovered. Antibiotic treatment with ceftriaxone led to a
progressive improvement in cognitive function and dyskinesia. After 2 weeks
of treatment, the patient became lucid and collaborative. She remembered
having experienced an erythematous and pruritic skin rash on her neck and
that episodes of loss of consciousness had been preceded by hyposthenia in
her right arm. Based on response to therapy the patient was diagnosed with
neuroborreliosis due to a Borrelia burgdorferi infection.


Lyme disease,neurology,Borrelia burgdorferi,mental disorders,nervous system
diseases,chronic course,symptoms,man,human diseases,chorea,tickborne

Abstract no: 990504767
Neuropathy of vasculitic origin in a case of Garin-Boujadoux-Bannwarth
syndrome with positive borrelia antibody response.
Camponovo F, Meier C
J Neurol 1986 Apr 233:2 69-72

A 42-year-old man suffered from erythema chronicum migrans on different
parts of the body after repeated tick bites. A few months after the last
tick bite he developed a painful neuropathy in both legs with patchy
disturbance of sensibility, mild weakness of the feet and loss of the right
ankle jerk. Repeated determinations of antibodies against borrelia
spirochetes revealed increasing IgG titres. Biopsy of the left sural nerve,
which was clinically and electrophysiologically affected, showed a
vasculitis of epineurial vasa nervorum and severe angiopathic lesions of the
perineurium and the neural parenchyma. Parenteral high-dose penicillin
treatment resolved the clinical symptoms.

{*filter*}, Antibodies, Bacterial, Bites and Stings, {*filter*} Vessels, Borrelia,
Borrelia Infections, Human, IgG, Male, Peripheral Nerves, Peripheral Nervous
System Diseases, Syndrome, Ticks, Vasa Nervorum, Vasculitis
Presse Med ? Volume 16 ? Issue 35

[Borrelian meningoencephalomyelitis. A case]
Benoit P, Dournon E, Masingue M, Destee A, Warot P
Presse Med 1987 Oct 24 16:35 1733-6

A 22-year old man had spastic paraparesis and cerebellar syndrome of 5
months duration. CSF showed lymphocytosis, elevated protein content,
hypoglycorachia, hypochlorurachia and oligoclonal banding. CT scan and MRI
were normal. Extensive laboratory procedures disclosed no bacterial, viral,
fungic, parasitic or inflammatory disease. Anti-Borrelia burgdorferi
antibodies were present in {*filter*} (1/4000) and in CSF (1/1024). With
antibiotics (penicillin G 20 millions units per day for 10 days, followed by
latamoxef 1.5 g per day for 3 months) and prednisone (50 mg per day for 2
months), the cerebellar signs disappeared, the paraparesis improved and the
CSF abnormalities disappeared; {*filter*} and CSF anti-Borrelia antibody levels
decreased. This case is an example of a severe form of CNS impairment by
Borrelia burgdorferi. In Europe, most reports show progressive para- or
tetraparesis with, sometimes, intellectual, cerebellar or cranial nerve
impairment. In some cases, the signs are less diffuse or more acute.
Lymphocytic meningitis is present with hyperalbuminorachia and oligoclonal
banding; hypoglycorachia is mentioned in only one other report. Diagnosis is
made by high {*filter*} and CSF antibody titers and demonstration of local
synthesis. As in syphilis, borrelian meningoencephalomyelitis could be the
third stage of the disease. Its treatment, often disappointing, consists of
antibiotics (penicillin G or latamoxef) and in some cases corticosteroids.

{*filter*}, Antibiotics, Antibodies, Bacterial, Borrelia Infections, Case Report,
English Abstract, Human, Male, Meningoencephalitis, Myelitis, Time Factors

Author Address
Service de Clinique neurologique, CHU de Lille.

[Borrelia burgdorferi infection with bilateral optic neuritis and
intracerebral demyelinization lesions]
Bialasiewicz AA, Huk W, Druschky KF, Naumann GO
Klin Monatsbl Augenheilkd 1989 Aug 195:2 91-4

In September, 1987, the authors saw a 25-year-old female patient with
retinal perivasculitis, cystoid macular edema and papilledema in her right
eye. The left eye was normal. Visual acuity was 0.2 (OD), 1.2 (OS). After
conventional infections had been ruled out systemic methylprednisolone
therapy was instituted, but the patient's condition deteriorated. In May
1988 she presented with papilledema and a ''neuroretinitis''-like finding in
her left eye; in her right eye advanced optic nerve atrophy; visual acuity
was 0.1 (OD) and 0.07 (OS). The laboratory workup revealed an acute phase of
a chronic Borrelia burgdorferi infection, with total immunoglobulins
(immunofluorescence test) of 1:1280 and an IgM of 1:650 (normal ranges:
total Ig up to 1.80, IgM up to 1:40). MRI showed multiple paraventricular
and subcortical demyelinating lesions. However, the cranial CT scan was
normal. After 14 days' treatment with doxycycline 200 mg/d, visual fields
and acuity improved to sc 0.2 (OD) and sc 0.1 (OS) (July, 1988). This case
of intracranial demyelinizating lesions associated with bilateral optic
neuritis in a serologically determined Borrelia burgdorferi infection is the
first of its kind described in the literature.

{*filter*}, Brain, Brain Diseases, Case Report, Demyelinating Diseases, English
Abstract, Female, Human, Lyme Disease, Macular Edema, Cystoid, Magnetic
Resonance Imaging, Optic Atrophy, Optic Nerve, Optic Neuritis, Papilledema

Author Address
Augenklinik mit Poliklinik der Friedrich-Alexander-Universit?t
Hautarzt ? Volume 39 ? Issue 10

[Acrodermatitis chronic atrophicans and sclerodermiform skin changes in
Borrelia infection]
Langer K, Diem E
Hautarzt 1988 Oct 39:10 647-51

A female patient with acrodermatitis chronica atrophicans and widespread
sclerodermiform skin lesions with a high IgG antibody titer against Borrelia
burgdorferi is presented. The rapid improvement after high-dose penicillin G
therapy and the course of the Borrelia antibody titer suggest a persistence
of the causative organism.

Acrodermatitis, Aged, Animal, Bites and Stings, Borrelia, Case Report,
English Abstract, Female, Human, IgG, Lyme Disease, Scleroderma,
Circumscribed, Skin, Ticks

Author Address
I. Universit?ts-Hautklinik Wien.

Thu, 18 Jul 2002 03:00:00 GMT
 [ 1 post ] 

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