A Rare Case of Lyme Neuroborreliosis Presenting as Bannwarth Syndrome in Texas
Aabishkar Bhattarai1, Manmeet Kaur1, Xiangping Li1
1Neurology, University of Texas Medical Branch (UTMB)
Objective:
Lyme disease is a spirochete infection acquired after inoculation of Borrelia burgdorferi with the bite of Ixodes tick, commonly encountered in Northeastern United States, characterized by erythema migrans, arthritis and meningitis. Here we present a rare case of Lyme neuroborreliosis (LNB) manifesting as a painful meningo-radiculitis (Bannwarth syndrome) with radicular pain, paresis, and cranial nerve involvement in Texas
Background:
73-year-old Caucasian male presented with a 10-day history of radiating lower back pain, followed by lower extremity weakness and then bifacial weakness. Although patient could not recall any tick bite, he travelled to Pennsylvania 2 months prior to the presentation in early July. Examination revealed bilateral R>L LMN facial palsy, reduced strength 4/5 in left lower extremity, diminished tendon reflexes in lower extremities, and distal symmetric polyneuropathy with no skin rash, fever, or meningeal signs. CSF analysis showed lymphocytic pleocytosis and elevated CSF proteins with normal CSF glucose (WBC 226, lymphocyte 80%, protein 251, and glucose 52). MRI brain and spine showed enhancement of bilateral 7th cranial nerves along with cauda equina nerve roots. CT chest showed multiple lung nodules, and biopsy of which were negative for sarcoidosis. Serum Lyme ELISA and B. Burgdorferi IgG and IgM as well as CSF Lyme Antibody were positive. He was treated with Doxycycline for 4 weeks with good neurological recovery
Conclusions:
Bannwarth syndrome is an uncommon manifestation of Lyme neuroborreliosis (LNB) in the United States. It is characterized by various clinical features, which often makes the diagnostic process challenging. In our case, the subacute onset of flaccid lower extremity weakness with diminished deep tendon reflexes as well as facial weakness mimicked Guillain-Barré syndrome (GBS). Physicians need to be aware of the rare neurological manifestations of Bannwarth syndrome, especially in non-endemic area like Texas. Early diagnosis and timely treatment with antibiotics could improve clinical outcome