SHM Converge Scientific Abstract ePoster Gallery-An Unusual Presentation of Neuroborreliosis

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This case report describes a 67-year-old man with an unusual presentation of neuroborreliosis, specifically Bannwarth syndrome, an uncommon early disseminated form of Lyme disease in the United States. He presented with one week of progressive bilateral upper extremity weakness, diplopia, neck pain, bilateral facial droop, and areflexia. Initial MRI of the brain and cervical spine was unrevealing, but lumbar spine MRI showed diffuse cauda equina enhancement. Cerebrospinal fluid analysis revealed elevated protein with albuminocytologic dissociation and mild pleocytosis. Because the presentation resembled atypical acute inflammatory demyelinating polyradiculoneuropathy (AIDP), he was started on intravenous immunoglobulin without improvement.<br /><br />Further history uncovered a tick bite two months earlier. Lyme serology was positive for IgM with confirmatory Western blot, and CSF testing was reactive for Lyme IgG. Electromyography showed asymmetric subacute cervical polyradiculopathy without demyelination, supporting a diagnosis of polyradiculoneuritis due to neuroborreliosis (Bannwarth syndrome). The patient improved after treatment with intravenous ceftriaxone.<br /><br />The discussion emphasizes that Lyme disease can cause a wide spectrum of neurologic manifestations, including cranial neuropathies, meningitis, encephalopathy, and radiculoneuritis. Bannwarth syndrome typically presents with painful radicular symptoms, weakness, sensory deficits, decreased reflexes, and often cranial nerve involvement. Because it can mimic other neurologic disorders such as AIDP, clinicians should maintain a high index of suspicion in patients with acute painful radiculoneuritis, especially when there is a history of tick exposure. Prompt serologic testing, lumbar puncture, imaging, and EMG can help establish the diagnosis and guide appropriate antibiotic treatment.

Asset Subtitle

Sandeep Buddharaju

Meta Tag

Author List Anacleto B. Diaz, Bradley Clemens, Hannah Bray, Kevin FitzGerald, Sandeep Buddharaju, Yajing Ji

Category Clinical Vignettes

Concept Bannwarth syndrome

Concept Lyme Neuroborreliosis

Concept Radiculoneuritis

Concept Two-tier Serologic Testing

Concept Ceftriaxone

Distinguished Non-Finalist

Presenter Organization Corewell Health

Presenting Author Sandeep Buddharaju

Track Adult

Keywords

neuroborreliosis

Bannwarth syndrome

Lyme disease

radiculoneuritis

tick bite

cranial neuropathy

cerebrospinal fluid

albuminocytologic dissociation

electromyography

ceftriaxone

Bannwarth syndrome

Lyme Neuroborreliosis

Radiculoneuritis

Two-tier Serologic Testing

Ceftriaxone