Lyme-associated parkinsonism: a neuropathologic case study and review
of the literature.

Cassarino DS, Quezado MM, Ghatak NR, Duray PH.

Laboratory of Pathology, National Cancer Institute, National Institutes
of Health, Bethesda, Md 20892, USA.

Neurological complications of Lyme disease include meningitis,
encephalitis, dementia, and, rarely, parkinsonism. We present a case of
striatonigral degeneration, a form of multiple system atrophy, in
Lyme-associated parkinsonism. A 63-year-old man presented with erythema
migrans rash, joint pains, and tremors. Serum and cerebrospinal fluid
antibodies and polymerase chain reaction for Borrelia burgdorferi were
positive. Clinical parkinsonism was diagnosed by several neurologists.
Despite treatment, the patient continued to decline, with progressive
disability, cognitive dysfunction, rigidity, and pulmonary failure. At
autopsy, the brain showed mild basal ganglia atrophy and substantia
nigra depigmentation, with extensive striatal and substantia nigral
neuronal loss and astrogliosis. No Lewy bodies were identified;
however, ubiquitin-positive glial cytoplasmic inclusions were
identified in striatal and nigral oligodendroglia. There were no
perivascular or meningeal infiltrates, the classic findings of
neuroborreliosis. To our knowledge, this is the first report of
striatonigral degeneration in a patient with B burgdorferi infection of
the central nervous system and clinical Lyme-associated parkinsonism.

Publication Types:
Case Reports
Review
Review of Reported Cases

PMID: 12946221 [PubMed - indexed for MEDLINE]