SHM Converge Scientific Abstract ePoster Gallery-A Tick Crawled Up and Then My Legs Went Down

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This case report describes a 46-year-old man from southwestern Maine who developed progressive bilateral lower-extremity numbness and weakness over two days, with symptoms ascending and eventually involving mild upper-extremity weakness. On examination, he had an ataxic gait, sensory loss in both legs, and absent deep tendon reflexes, raising concern for Guillain-Barré syndrome (GBS). MRI of the brain and spine was unrevealing, and lumbar puncture showed albuminocytologic dissociation, supporting the diagnosis. He was started on IVIG.<br /><br />Because he lacked the typical preceding respiratory or gastrointestinal illness, additional evaluation for alternative causes was pursued. Tick-borne testing was negative for Lyme disease and anaplasmosis but positive for Babesia by PCR. He was treated with atovaquone and azithromycin in addition to IVIG. After treatment began, his symptoms stabilized and gradually improved, and he was discharged to rehabilitation.<br /><br />The report reviews GBS as an autoimmune demyelinating disorder that commonly causes ascending weakness, areflexia, and sensory symptoms, often following infection. Babesiosis, a tick-borne protozoal infection transmitted by Ixodes scapularis, typically causes fever, fatigue, malaise, and weakness, but neurologic complications are rare. The authors note that only a few cases have linked babesiosis to GBS, making this association unusual but plausible.<br /><br />The main conclusion is that babesiosis should be considered as a possible trigger of GBS, especially in patients from endemic areas who do not have a typical antecedent illness. Clinicians are encouraged to maintain a high index of suspicion for tick-borne disease when evaluating unexplained GBS.

Asset Subtitle

Matthew Rivkin

Meta Tag

Author List Claudia K. Geyer, Matthew Rivkin, Nicole Boutaugh, Seth Stein

Category Clinical Vignettes

Concept Guillain-Barré Syndrome

Concept Ascending Weakness

Concept Areflexia

Concept Babesiosis

Concept Albuminocytologic Dissociation

Distinguished Non-Finalist

Presenter Organization Central Maine Medical Center

Presenting Author Matthew Rivkin

Track Adult

Keywords

Guillain-Barré syndrome

babesiosis

tick-borne disease

ascending weakness

albuminocytologic dissociation

areflexia

Ixodes scapularis

IVIG

atovaquone

azithromycin

Guillain-Barré Syndrome

Ascending Weakness

Areflexia

Babesiosis

Albuminocytologic Dissociation