SHM Converge Scientific Abstract ePoster Gallery-Treatment-Associated Inflammatory Response in Lyme Neuroborreliosis

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This case describes a 33-year-old previously healthy woman with Lyme neuroborreliosis who developed progressive weakness, distal dysesthesias, facial palsy, and back pain. She was initially treated for bilateral Bell’s palsy with corticosteroids, then started on doxycycline after Lyme IgG was positive. As her neurologic symptoms worsened, she was hospitalized and escalated to IV ceftriaxone via PICC for presumed treatment failure.<br /><br />On transfer/admission, she had improved facial palsy but ongoing neuropathic pain, decreased grip strength, mild bilateral leg weakness, reduced upper-extremity reflexes, and an unsteady gait. CSF showed elevated protein but no pleocytosis. MRI demonstrated enhancement of the proximal cauda equina and a T6 nerve root, consistent with inflammatory radiculoneuritis. Because there was no objective evidence of active infection and some cranial neuropathy had already improved, IV ceftriaxone was stopped, the PICC was removed, and she was discharged to complete oral doxycycline.<br /><br />After discharge, EMG showed a primarily demyelinating polyneuropathy with secondary axonal loss, findings that can resemble Guillain-Barré syndrome but are also consistent with demyelination seen in Lyme neuroborreliosis. She later received a steroid burst and IVIG and returned to her functional baseline within 40 days.<br /><br />The key teaching point is that worsening neurologic deficits in Lyme neuroborreliosis may reflect an inflammatory treatment-associated response rather than true antibiotic failure. Clues supporting this include improving cranial neuropathy, nerve root enhancement on MRI, and absence of CSF pleocytosis. The report also emphasizes that oral doxycycline is noninferior to IV ceftriaxone for most cases and avoids the added risks and costs of PICC-based outpatient IV therapy.

Asset Subtitle

Katelyn Stuart

Meta Tag

Author List Deepak Rai, Katelyn Stuart, Matthew Yoder

Category Clinical Vignettes

Concept Lyme Neuroborreliosis

Concept Inflammatory Worsening

Concept Antimicrobial Treatment Failure

Concept Doxycycline

Concept Cranial Neuropathy

Distinguished Non-Finalist

Presenter Organization The Ohio State University College of Medicine

Presenting Author Katelyn Stuart

Track Adult

Keywords

Lyme neuroborreliosis

demyelinating polyneuropathy

facial palsy

radiculoneuritis

ceftriaxone

doxycycline

PICC line

CSF protein

MRI nerve root enhancement

IVIG

Lyme Neuroborreliosis

Inflammatory Worsening

Antimicrobial Treatment Failure

Doxycycline

Cranial Neuropathy