Bannwarth syndrome and weight loss – an atypical case

Bannwarth syndrome is a neurological disease caused by an infection with Borrelia burgdorferi, the bacterial agent of Lyme disease. The disease causes intense nerve pain and is characterized by “painful radiculopathy, neuropathy, varying degrees of motor weakness, lower motor neuron (LMN) facial nerve palsy and cerebrospinal fluid (CSF) lymphocytic pleocytosis,” writes Diaz et al. in the journal Clinical Neurology and Neurosurgery.

Bannwarth syndrome is typically seen in Europe. However, in 2017 doctors from Mayo Clinic described 5 patients with the disease living in Minnesota and Wisconsin. All of the patients presented with peripheral neuropathy.

Now, a 2019 case report by Diaz ¹  describes a 60-year-old man from the United States with a variant Bannwarth syndrome. The man initially presented with high liver function tests and weight loss of approximately 25 lbs.

For 3 weeks he experienced progressive back pain, along with peripheral neuropathy, which included arm and leg weakness, numbness in his hands and a right facial droop. Shortly after he was admitted to the hospital, the man developed a complete facial palsy.

“Throughout this time, severe central back pain persisted requiring neuropathic pain agents and opiates for adequate pain-control,” writes Diaz.

An EMG and nerve conduction study of his upper and lower body demonstrated prolonged distal latencies and slowed conduction velocity seen in polyradiculopathy.

The spinal tap revealed a lymphocytic pleocytosis (96%) and elevated protein (156) consistent with lymphocytic pleocytosis.

[bctt tweet=”A patient with Bannwarth syndrome due to Lyme disease presents with liver dysfunction and weight loss.” username=”DrDanielCameron”]

His serologic and spinal fluid was positive for Lyme by Western blot IgG. The serologic test revealed only one IgM band. A CSF:serum antibody index assay was not performed.

Anaplasmosis was considered as the cause of transaminitis (high liver function) but the tests were negative. Serologic tests were positive for Babesia but there was no evidence of parasites in his blood.

The man’s evaluation led to a diagnosis of a variant Bannwarth syndrome. And he was treated successfully with 4 weeks of intravenous ceftriaxone.

“On follow-up at 2 months, facial paralysis, pain, motor, and sensory deficits had resolved with return to baseline weight and liver function tests,” the authors write.

“Our case demonstrates the importance of consideration of Bannwarth syndrome in the differential of meningoradiculitis, even in the setting of atypical features such as liver dysfunction and weight loss,” writes Diaz.

Editor’s note: This case suggests the need to look for Bannwarth syndrome in patients living in the U.S. It also highlights the importance of considering this condition in patients who present with painful radiculopathy, neuropathy, varying degrees of motor weakness, and lower motor neuron (LMN) facial nerve palsy, even with a normal spinal tap.

  1. Diaz MM, Wesley SF. Meningoradiculitis and transaminitis from neuroborreliosis: A case of variant Bannwarth syndrome. Clin Neurol Neurosurg. 2019 Sep 23;186:105532.

5 Replies to "Bannwarth syndrome and weight loss - an atypical case"

  • Kari Mosher
    01/09/2024 (7:31 pm)

    Dr. Cameron, I have a friend who started showing signs of lyme disease a year ago. I told her to get tested for it. Her provider refused and told her she didn’t need to be tested for it. After a year of her declining, they finally did a test. IGM positive Lyme total AB EIA positive. The provider proceeded to tell her that she does not have Lyme and was “only exposed to it”. She started having visual disturbances that she described as a rainbow. She went to a neurologist, they told her migraines. Started her on topamax. She started having severe swelling in her legs, so they put her on a thiazide to help pull the fluid off her legs and feet. She has continued to decline and is now on the verge of giving up. She went from 170 pounds to 95 pounds in a span of 6 months. Her PCP continues to tell her that there is nothing wrong with her. She eats and has been trying to gain weight. She stopped the topamax months ago bc she had lost so much, but continues to go down in weight. She now has neuropathy, sleeps all the time, she has a hard time walking and has to hold on to something or she can’t get around. If you have any suggestions, or would be willing to see her. I strongly believe that she has a coinfection present. The PCP’s that don’t understand Lyme disease or the risks that come with it. I have a very good friend who came to you, and that is why I am messaging you. Thank you so much for your time.

    • Dr. Daniel Cameron
      01/10/2024 (6:39 am)

      I am still seeing patients with similar presentations to your friend. I wish the tests were more reliable. You can direct your question to my office.

  • Sue
    07/09/2021 (11:10 am)

    I was recently diagnosed with Bannwarth syndrome after suffering for nearly 3 years with nerve issues. Saw lots of doctors before finally a very posity test. (3 IGM, 8 IGG). I completed two rounds of doxy and 30 days of ceftriaxon IV.

    After the neurologists, one said Bannwarth, who said your nerves are damaged and live with it. I’m already taking hydrocodone daily, with propanalol for tremors.
    I’m having a real hard time accepting ” live with it”. Do you know if anything that can treat this horrible syndrome?

  • Patty
    04/05/2020 (5:37 am)

    Dr Cameron,
    have you ever seen a case of Kluver Bucy from Lyme or any of the coinfections? Hyperphagia and visual agnosia as dominant. I am confident KBS describes the condition because I got prosopagnosia from antibiotics. Many symptoms vary in intensity but it’s never as before onset of POTS/Hashimoto/SFN
    there was nothing on MRI and spinal tap was normal.
    Although both were done 15 years after the onset.
    The symptoms started along with Hashimoto, POTS, and numbness of the left face.15 years later I found out I also have Sjogrens which was presenting as POTS but now also sicca (15+ yrs no sicca but only mild parotid swelling from start of disease)
    I read KBS might come from tirgeminal nerve path virus entering the head?

    -But I am negative to HSV1/2 even.
    mycoplasma negative
    chlamydia IgG pos,
    Lyme LTT high positive, after it become negative not much help in KBS

    my KBS symptoms do respond to essential oils antibiotics and to IVIG, but never fully. Overall 3+ years of various antibiotics just made me worse and tons of herxing but my autoimmunity grew stronger it seems.

    I wonder if it’s gut related, there seems like low grade inflammation of my head but especially areas linked to KBS symptoms.

    Thank you

    • Dr. Daniel Cameron
      04/07/2020 (6:47 pm)

      Kluver Bucy syndrome is a rare behavioral impairment characterized by inappropriate sexual behaviors and mouthing of objects. Other signs and symptoms include a diminished ability to visually recognize objects, loss of normal fear and anger responses, memory loss, distractibility, seizures, and dementia according to I have not seen KBS.

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