Dr. Daniel Cameron: Inside Lyme Podcast

Bannwarth syndrome in early disseminated Lyme disease

Welcome to another Inside Lyme Podcast with your host Dr. Daniel Cameron. In this episode, Dr. Cameron will be discussing the case of a 66-year-old man with Bannwarth syndrome with urinary retention in early Lyme disease.

Omotosho and colleagues described this case in an article entitled “A Unique Case of Bannwarth Syndrome in Early Disseminated Lyme Disease.”¹

The man presented to the emergency room with generalized myalgia, fatigue, and severe neck pain. The symptoms had been occurring for two weeks and began shortly after he was bitten by two ticks while performing yard work.

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The patient reported having dull mid-back pain, intermittent headaches, and neck stiffness. His doctor initially suspected he had pneumonia and prescribed an antibiotic. But his symptoms worsened.

“His pain then radiated down his entire spine into his upper and lower extremities, leading to right arm weakness and new urine retention onset,” the authors wrote.

“His paraspinal tenderness and diminished deep tendon reflexes bilaterally.” His pain score was 8 out of 10. The ESR rate was 100 and C-reactive protein of 8.8 mg/L.

“Physicians need to be aware of the rare neurological manifestations of [Lyme neuroborreliosis] … Prompt diagnosis and treatment with antibiotics can reduce unnecessary imaging, patient anxiety, and, most importantly, avert debilitating complications.”

Test results indicated a white blood cell count of 12 k/uL, C-reactive protein of 8.8 mg/L, sedimentation rate of 100 mm/h, and creatinine kinase of 27 units/L.

Western blot and ELISA Lyme disease tests were positive and confirmed an early stage infection with Borrelia burgdorferi. In addition, a spinal tap showed lymphocytic pleocytosis and a positive Lyme disease titer.

The man was diagnosed with Bannwarth syndrome (BWS) based on his severe radiculopathy, upper extremity weakness, and urinary dysfunction. “All of these findings are pathognomonic for [Bannwarth syndrome],” wrote the authors.

Typically, Bannwarth syndrome affects a person’s limbs. In this case, Lyme disease induced sacral radiculitis leading to neurogenic urinary dysfunction.

The authors were not sure why the patient’s urinary tract was affected. They suggested, “the influence of the radiculitis on innervating fibers” and “direct invasion of the spirochetes into the bladder wall” might have played a role.

“Early recognition of this rare presentation associated with Lyme disease and treatment with antibiotics can prevent disease progression and detrimental neurological sequelae.”

The man was treated with a 21-day course of IV ceftriaxone and “his symptoms improved with complete resolution of his urinary retention,” the authors wrote.

About Bannwarth syndrome

Bannwarth syndrome has been reported most often in Europe. And despite disputes over its incidence in the United States, “the condition does occur but is often misdiagnosed.”

BWS is characterized by a wide range of symptoms including radicular pain (100%), sleep disturbances (75.3%), headache (46.8%), fatigue (44.2%), malaise (39%), paresthesia (32.5%), peripheral nerve palsy (36.4%), meningeal signs (19.5%), and paresis (7.8%), according to the authors.

The syndrome can cause severe pain. “BWS typically manifests itself with severe zoster-like segmental pain that is worse at night,” the authors wrote. “The pain has a burning, stabbing, biting, or tearing character and usually responds poorly to all common analgesics.”

Author’s Conclusion:

“The constellation of neurological symptoms, particularly when associated with a recent or suspected tick bite in an endemic region, should prompt thorough evaluation for [Lyme neuroborreliosis] and assessment for BWS,” the authors wrote.

The following questions are addressed in this Podcast episode:

  1. What is Bannwarth syndrome?
  2. How is BWS diagnosed and treated?
  3. What is radicular pain?
  4. What is the significance of the spinal tap findings?
  5. What is the significance of an elevated sedimentation rate and c-reactive protein?
  6. Why is BWS rarely diagnosed in the USA?
  7. What can we learn from this case?

Thanks for listening to another Inside Lyme Podcast. Please remember that the advice given is general and not intended as specific advice to any particular patient. If you require specific advice, please seek that advice from an experienced professional.

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References:
  1. Omotosho YB, Sherchan R, Ying GW, Shayuk M. A Unique Case of Bannwarth Syndrome in Early Disseminated Lyme Disease. Cureus. Apr 25 2021;13(4):e14680. doi:10.7759/cureus.14680


4 Replies to "Bannwarth syndrome in early disseminated Lyme disease"

  • Michael A Murphy
    01/31/2022 (2:50 pm)
    Reply

    This is my story about Lyme, Baanwarth Syndrome and receiving a Tetanus Booster Shot two years after contracting Lyme Disease

    I came down with BAANWARTH SYNDROME in March of 2001 almost two years after I unknowingly was infected with Lyme & Babesia in 1999.

    On February 15th, 2001 I was given a Tetanus Booster Shot and came down with chronic pain nearly three day later. Lyme and Babesia had turned off my immune system in June of 1999. I had two False Negative ELISA tests because I had a raging case of re-activated EBV.

    Doctors denied I had Lyme even though I had every symptom for Lyme. In 2005 I had neck surgery for the chronic pain that I was in. At New England Baptist I had a Cervical Disectomy with fusion and a titanium cage after they removed C3-C5.

    Of course it made my pain much, much worse and I was put on heavy drug medication fort which I needed.

    Nobody figured out that I had Lyme or Babesia. I would later learn in 2001 that I was vaccinated with a Tetanus Booster almost two years after I contracted Lyme and Babesia. No Doctor would ever give a patient with Lyme Disease a Tetanus Vaccination, if they knew they had it.

    I was fired by my local Doctor for not being able to manage my pain, after all my pain was caused by an ADVERSE EVENT to a Vaccine that should never have been given to me. I was on gabapentin for nerve pain and ritalin for focus.

    I didn’t need a booster shot for two more years but they recommended the shot and I got it at a routine appointment. The real awful part of this story is that I went a full 15 years before I was able to get a positive Western Blot test and a positive Babesia Test and begin to receive medication for my infections..

    I had been tested for Lyme and Babesia twice and they were both false negative because I had Mono as a kid that turned into a raging Epstein Barr Virus after contracting Lyme in June of 1999..

    From 2014-2016 I took two years of antibiotics and other treatments for Lyme & Babesia.

    I was reinfected 3 months later from a tic bite on my front porch which gave me Powassan Virus in less than 15 minutes, plus Erhlichia-Anaplasmosis, Lyme & Babesia Duncani (2nd time) and Powassan virus which no one would tests me for even today!

    I was treated again from 2018-2021 and I finally recovered from the Lyme and Babesia. I live in chronic pain and will be on PAIN MEDS FOR THE REST OF MY LIFE.

    I HOPE THIS STORY HELPS SOMEONE WHO LIVES in chronic Pain that might have been from a routine tetanus booster that was given after they had contracted Lyme. I believe the tetanus shot plus Lyme gave me Transverse Myelitis and Baanwarth’s Syndome.

    I was not able to find peace in my life until I discovered “WHAT REAALY HAPPENED TO ME” some two years after I was infected with Lyme. If you are a Lyme survivor who is still in chronic pain, please check your medical records for vaccinations.

    Of course, no one in the medical community will help you after your discovery of a being given a Tetanus vaccine. My experience anyway.

    Vaccine Adverse Event Reporting System is only good for three years.

    We pay .50 cents every time we get a vaccine and it goes into a slush fund to pay the medical bills of people who were injured by a vaccine. Of course after three years you can not make a claim. Crappy system.

    I get all of my pain medication from a clinic and not a medical Doctor because the medical system is horribly broken, especially for people trying to get well after years of chronic Lyme Disease. Knowing what caused all of my pain has helped me tremendously! I never thought it would have been a routine vaccine.

    Please check your Vaccination Records if you have Lyme and live in pain and don’t know why.

    Sincerely,

    Michael A Murphy

  • Joel P.
    12/06/2021 (12:23 pm)
    Reply

    Been diagnosed with Babesia, whenever I go off Mepron for more than 3-4 days, I get very clear urine retention.

  • Dasha Trebichavska
    11/22/2021 (6:10 pm)
    Reply

    I have came across an article which mentioned that Borrelia weakens immune system. It aparently blocks D receptors on the cells…

    • Dr. Daniel Cameron
      11/23/2021 (7:13 am)
      Reply

      There are quite a number of suggested mechanisms for why tick borne illnesses can be difficult to treat. I follow these mechanisms closely. I do not know enough to be sure what mechanism will emerge for each tick borne infection.


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