Six cases of neuroinvasive Lyme disease

A cluster of six neuroinvasive Lyme disease cases is described by doctors from Mayo Clinic in the journal Open Forum Infectious Diseases. [1] Over a 3-week period between July and August of 2017, physicians from the Minnesota and Wisconsin campuses identified 6 patients with Lyme neuroborreliosis. Five of these cases presented with Bannwarth syndrome (BWS), an uncommon manifestation of neuroinvasive Lyme disease, which is typically seen in Europe, explains Shah and colleagues.

 

Bannwarth syndrome is characterized by painful radiculopathy, neuropathy, varying degrees of motor weakness and facial nerve palsy, and cerebrospinal fluid (CSF) lymphocytic pleocytosis. Five patients, Shah says, presented with peripheral nervous system involvement (primarily axonal in nature), which is consistent with BWS. We discuss three of the cases below.

61-year-old male

A 61-year-old male, who had a history of daily exposure to ticks, presented with “progressive back pain, upper torso and extremity paresthesias, right-sided facial droop, and blurry vision in the right eye,” writes Shah. Four weeks prior, he was treated for an EM rash with 5 days of doxycycline, given twice daily.

Test results indicated positive IgM and IgG antibodies to B. burgdorferi and he was diagnosed with LNB/BWS. According to Shah, “the patient demonstrated significant neurologic improvement following 4 weeks of intravenous (IV) ceftriaxone.”

62-year-old female

A 62-year-old female presented with subacute onset of lower extremity weakness. This progressed over a 3-week period to flaccid paralysis, writes Shah. The woman also complained of radiating low back and abdominal pain with associated numbness.

Tests confirmed the diagnosis of BWS and Lyme neuroborreliosis (LNB). “A magnetic resonance image (MRI) of her spine showed diffuse inflammation of the cauda equine,” says Shah. A pleocytosis by spinal tap and a positive real-time polymerase chain reaction (RT-PCR) assay confirmed the diagnosis.

The patient was diagnosed with LNB/BWS and discharged on a 4-week course of IV ceftriaxone. “The patient reported improved mobility,” says Shah, “though she still required extensive assistance 2 months post-treatment.”

29-year-old male

In June 2017, a 29-year-old male developed fever, myalgias, chills, headache and fatigue. He also reported a transient erythematous rash on his trunk. Two weeks later, he developed “right foot drop, Trendeleberg gait, lower extremity radiculopathy, and painful L5-S1 paresthesias,” explains Shah. And over the next 10 weeks, he lost 15 pounds.

After refusing a spinal tap, the man was diagnosed based on his clinical presentation and positive Lyme test results. The man was given IV ceftriaxone and two weeks later reported having no symptoms. It is not clear how often BWS occurs in actual practice with or without a confirmatory spinal tap.

All five patients presented with upper or lower extremity radiculopathy and/or paresthesias. There were, however, several other findings. “The more widespread peripheral neuropathy observed for the remaining 3 patients in this series is somewhat atypical,” writes Shah. “2 patients developed visual disturbances and nerve root enhancement in the cauda equine or lumbar spine, and 1 presented with Lyme disease–associated facial nerve palsy.”

The authors recommend, “The constellation of neurological symptoms, particularly when associated with a recent or suspected tick bite in an LD-endemic region, should prompt clinical evaluation for LNB and assessment for BWS as this syndrome may be more common than previously presumed in North America.”

References:

  1. Shah A, O’Horo JC, Wilson JW, Granger D, Theel ES. An Unusual Cluster of Neuroinvasive Lyme Disease Cases Presenting With Bannwarth Syndrome in the Midwest United States. Open Forum Infect Dis. 2018;5(1):ofx276.


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Beth
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Beth

Hang in there and keep advocating for yourself. Keep looking for a doc that will listen. My darling daughter had bad symptoms for 3+years that we were told were all in her head. She has been since diagnosed with Lyme and we are finally getting treatment. It took me one day, saying NO, no more telling us there’s nothing wrong with her. Hang in there. Reach out to Lyme community, Facebook has been a good place for me, as her mom. Best of luck!

Pam H
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Pam H

My symptoms began with strange double vision, and nerve pain in my hands feet, including a burning /stabbing feeling at the bottom of the soles of my feet, all this one time for approximately two weeks. Now I have short term memory loss, inability to concentrate, letter reversal when spelling, extreme anxiety oh, a 40 pound weight loss, a 40 pound weight gain. I am thinking about being seen by Mayo clinic however I’ve heard negative reviews about them when testing for Lyme disease. I don’t know what to do because where I live all the Doctors and Hospital Systems… Read more »

China
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China

Diagnoses around 1988 and treated with in three weeks of a tick bite. I thought I was cured after taking the RX. Forgot about it until two months ago while conversing with some they had told me they have Lyme Disease and I had mentioned that I “had” it. I was told to get a test from my PCP…tested positive 2018 and to Doxicycline for 30 days. Went for an eye exam and shared an temporary blindness in one eye for 2-3 mins. one summer day, passed out twice (hit my head on sink’s edge on my way down). Past… Read more »

Colleen
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It bothers me they still.insist on spinal tap when the regular unintrusive blood smear does the same thing…

Ellen Boehmer
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Ellen Boehmer

…but the blood tests are not always positive. Mine were negative but lumbar puncture revealed the antibodies.

Kelly-Anne Bryan
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Kelly-Anne Bryan

Yeah, I had same type symptoms, never recognized for what it was. It actually resolves and relapses. Pretty sure this is VERY common in Lyme.

TC
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Quote- “… this syndrome may be more common than previously presumed in North America.” YA THINK? That’s why we call it Hold The Mayo! And they are just now figuring this out (or admitting it)? UGH!