Chronic inflammatory demyelinating polyneuropathy (CIDP) case resolved with antibiotics

Lyme disease has been ruled out in other conditions based on negative serologic tests only to seroconvert to positive serologies on follow-up. [1,2] This was demonstrated in the case of a 41-year-old woman with chronic inflammatory demyelinating polyneuropathy (CIDP), according to Perronne from the Infectious Diseases Unit, University Hospital Raymond Poincaré, APHP, Versailles Saint Quentin University, Garches, France.

 

The woman presented with asthenia, weakness, and diffuse paresthesias. The electromyography assessment showed mild demyelination. Lyme disease was ruled out based on negative serum and cerebrospinal fluid serologic tests.
Intravenous immunoglobulin treatment was performed 8 times for CIDP with subsequent partial response and relapse.

Chronic inflammatory demyelinating polyneuropathy is a neurological disorder in which there is inflammation of nerve roots and peripheral nerves and destruction of the fatty protective covering (myelin sheath) over the nerves. It causes progressive weakness and impaired sensory function in the legs and arms. [3]

Lyme disease was diagnosed 10 months after the onset of the clinical symptoms when a serum polymerase chain reaction analysis disclosed the presence of Borrelia (100 copies/mL).

The woman, who was then treated successfully with 6 weeks of doxycycline and hydroxychloroquine, showed “a dramatic clinical improvement” with a complete disappearance of neurologic signs, according to Perronne.

The authors advised against automatically ruling out Lyme disease based on negative serologic tests. “In our opinion, Lyme formal serology negativity is insufficient to rule out early (erythema migrans) and late chronic Lyme disease diagnosis.”

 

References:

  1. Perronne C, Lacout A, Marcy PY, El Hajjam M. Errancy on Lyme Diagnosis. Am J Med. 2017;130(5):e219.
  2. Cameron DJ. Consequences of treatment delay in Lyme disease. J Eval Clin Pract. 2007;13(3):470-472.
  3. National Center for Advancing Translational Sciences. https://rarediseases.info.nih.gov.


1 Reply to "Chronic inflammatory demyelinating polyneuropathy (CIDP) case resolved with antibiotics"

  • Lisa Shepherd
    06/16/2021 (5:41 am)
    Reply

    I had a positive IGG western blot test in May 2020 after receiving multiple ticks bites in the Dordogne region of France over a period of several years. No rash was ever detected.
    Symptoms elevated in the last 3 months seem to be an exact replica of those described in this article, however the doctors in Norway, where my my MRI and lumbar puncture were performed expressed that the mild demyelination that showed was indicative of a “ normal” result for my age (55). Even though borrelia antibodies were found in the spinal fluid it was assessed as being negative for borreliosis. It seems very difficult to confer with a LLMD in Europe and they do not exist in Scandinavia. I am currently still on a two month waiting list with a LLMD in the Netherlands. It would be so helpful to speak with someone who has expertise in this field.


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