A case of neuroborreliosis with unilateral radiculoneuropathy and elevated serum antibodies for Borrelia garinii and Borrelia afzelii.
Miyazaki K, Iijima M, Takeuchi M, Uchiyama S, Iwata M Department of Neurology, Tokyo Women's Medical College.
A 24-year-old male patient was admitted to our hospital because of dysesthesia and weakness of the right leg.
Six weeks before admission he traveled to southern China. A week later he noticed multiple papules with itching on his right leg that were suspected to be insect bites.
Four days later numbness of the right leg developed. Then he began to limp because of the leg weakness. Two weeks before admission severe pain in the right leg developed.
On admission neurological examination revealed hypesthesia, muscle weakness and atrophy, areflexia, radicular pain and Lasegue sign of the right leg, and patchy hypesthesia of the left leg. The cranial nerves were intact, and meningeal signs were negative. Complete blood counts and serum biochemistry were unremarkable except for eosinophilia and mild elevation of IgE. A test for antinuclear antibody was positive. Cerebrospinal fluid was normal.
Nerve conduction study and sural nerve biopsy showed multifocal severe axonopathy.
Although antibody for Borrelia burgdorferi sensu stricto was negative, antibodies for B. garinii and for B. afzelii were positive in serum immunoblotting.
Neurological symptoms improved after administration of intravenous ceftriaxon following oral doxycycline.
In Japan, this is the second case of neuroborreliosis not due to B. burgdorferi sensu stricto. To test antibodies for B.garinii and for B. afzelii is recommended in patients with suspected neuroborreliosis.
Publication Types: Review Review of reported cases PMID: 8997140
