neuroborreliosis and guillain-barrÉ syndrome: could …
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References: Beth AR. Guillain-Barré Syndrome. Pediatrics in Review 2012; 33:164-171; Eugene DS. Lyme disease: Clinical manifestations in children. Available in www.uptodate.com (2015); John JH. Nervous system Lyme disease. Available in www.uptodate.com (2015); Lisa VA. Tuberculosis disease in children. Available in www.uptodate.com (2015); Niharika T, Tim M, Sunil W. Neuroborreliosis: the Guillain-Barré mimicker. BMJ Case Rep 2015; 10:1-3; Suraj AM, et al. Antibiotic Responsive Demyelinating Neuropathy Related to Lyme Disease 2009; 72:1786-1787.
NEUROBORRELIOSIS AND GUILLAIN-BARRÉ SYNDROME: COULD BE THE SAME DISEASE?
A Garcia1, JP Vieira2, MJ Brito1 1 Infectious Diseases Unit, 2 Department of Pediatric Neurology
Hospital de Dona Estefânia. CHLC. EPE, Lisbon Head of Department: Gonçalo Cordeiro Ferreira
PORTUGAL
CASE REPORT
Bacterial tonsillitis
5-week follow-up
Neurologic examination almost normal
Autonomic dysfunction slower recovery
Evolution
Without clinical improvement
D0 D5 D10
♂, 4 year-old boy 10-day history
Rural environment
Lower extremity weakness
Pain
Urinary and fecal incontinence
Physical examination
Global symmetrical weakness
Bilateral lower limb areflexia
Gower´s sign
Neck stiffness
5-day before
Ceftriaxone (14 days)
GUILLAIN-BARRÉ SYNDROME
NORMAL Complete blood count Acute phase reactants
Ionogram and creatine kinase
Lumbar puncture
ALBUMINOCYTOLOGIC DISSOCIATION white blood cell count normal (0,8/uL)
protein concentration elevated (211,2 mg/dL)
Electromyogram
DEMYELINATING POLYNEUROPATHY
Additional investigation
POSITIVE
IgG anti-Borrelia burgdorferi (serum by ELISA + Western blot)
IgM anti-Borrelia burgdorferi (CSF by ELISA)
Cultures sterile (feces and CSF)
Serology to EBV and Mycoplasma negative
VDRL negative PCR to enterovirus negative
ANA, dsDNA and anti-GQ1b negative
Immunoglobulin Amoxicillin/clavulanic acid
NEUROBORRELIOSIS
CONCLUSION This case report highlights an uncommon presentation of neuroborreliosis. The presence of cerebrospinal fluid (CSF) Borrelia
burgdorferi antibody, which is highly specific for nervous system Lyme disease, suggests that Borrelia infection and a demyelinating
polyneuropathy with clinical, laboratory and neurophysiologic findings characteristic of Guillain-Barré syndrome occurred at the
same time and are causally related. This has been reported very rarely and usually the CSF profile reveal a slight lymphocytic
pleocytosis.
INTRODUTION: Lyme disease (LD) is a tick-borne illness caused by three pathogenic species of the spirochete Borrelia, which lead to a broad
spectrum of clinical manifestations. The classic triad of neurologic LD is lymphocytic meningitis, cranial neuropathy and
radiculoneuritis. These neuropathies are commonly related to multifocal axonal polyneuropathy although rare cases of
demyelinating neuropathies have been reported in Lyme disease
Correspondence: