RECIDIVANT NEUROBORRELIOSIS - CASE REPORT
Abstract
We present a case of a young woman age 34 who presented with recurrent Lyme neuroborreliosis (LNB). Her clinical picture consisted of rare combinations of two third stage manifestations, namely progressive encephalomyelitis and peripheral neuritis in both bouts of the disease. Epidemiological data were controversial as she had tick byte only two months earlier. Negative magnetic resonance imaging (MRI) excluded multiple sclerosis, vascular causes and tumors. Serological tests confirmed the Bb infection in recommended two step serological approach with enzyme-linked immunosorbent assay (ELISA) test for Borrelia burgdorferi (Bb) immunoglobulin G (IgG) and immunoglobulin M (IgM) and Western Blot (WB) as confirmatory analysis in the blood. Another controversial issue is the lack of pleocythosis. Atypical findings in our patient can be explained by possible rare genotype of Bb. After treatment with oral doxycycline, she made apparent remission, but after three months she had another episode with signs of central and peripheral nervous system involvement, increased Bb antibodies and white matter changes on MRI. This time, she was treated with intravenous ceftriaxone, two grams daily for four weeks. She showed no signs of LNB, both clinically and serologically during a follow up lasting about a year. This case emphasizes the importance of clinical and serological findings and ceftriaxone as the first line treatment in LNB.
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