Case report: Lyme neuroborreliosis with encephalitis

Investigators describe what they believe is the first case of confirmed Lyme neuroborreliosis encephalitis with significant parenchymal MRI changes in a broadly immunosuppressed patient.

A 74-year-old woman had been hospitalized four times over a period of three months. During these admissions, she was treated with antibiotics for a urinary tract infection, states Rosendahl and colleagues in their article “Lyme neuroborreliosis with encephalitis: A rare case.”¹

On her last admission, the woman exhibited confusion, paranoid delusions, a weight loss of 33 lbs., back pains, history of fever and vomiting suspect of cancer and infection of unknown origin, leading doctors to suspect she suffered from a central nervous system (CNS) infection.

“We present a case of Lyme neuroborreliosis with encephalitis with significant parenchymal inflammation on magnetic resonance imaging (MRI) in an immunosuppressed patient.”

A lumbar puncture was performed and she began empirical treatment for bacterial meningitis and viral encephalitis, which included benzylpenicilline, ceftriaxone, aciclovir and dexamethasone.

The woman reportedly had no history of a tick bite or an erythema migrans (EM) rash or painful meningoradiculitis. However, approximately 3 months earlier she was treated for a universal skin rash.

“An MRI showed hyperintensities in basal ganglia, thalami, medial temporal lobes and mesencephalon and hereby confirmed the diagnosis of [Lyme neuroborreliosis] encephalitis,” according to the authors.

The woman was treated successfully with intravenous ceftriaxone and oral doxycycline for Lyme neuroborreliosis.

“Follow-up brain MRI showed complete remission of previous hyperintensities in basal ganglia and thalamus,” the authors state. “At 6 months follow-up, the patient had improved but still reported some memory problems.”