Early Lyme neuroborreliosis manifesting as brachial plexopathy and meningitis in Northwestern Ontario, Canada: A case report. Issue 45 (11th November 2022)

• Record Type: Journal Article
• Authors: Gu, Kaien; Boodman, Carl; Orr, Pamela; Wuerz, Terence
• Is Part Of: Medicine. Volume 101:Issue 45(2022)
• Page Start: e31576
• Publication Date: 2022-11-11
• Subjects: case report -- Lyme disease -- Lyme neuroborreliosis; Medicine -- Periodicals; Medicine -- Periodicals; Médecine -- Périodiques; Geneeskunde; Medicine; Periodicals; Periodicals; 610.5
• DOI: 10.1097/MD.0000000000031576
• Languages: English
• ISSNs: 0025-7974

Abstract

Abstract : Rationale: Lyme disease is a tick-borne disease caused by the spirochete B. burgdorferi, and patients often present with symptoms comparable to a viral-like illness. The diagnosis can be challenging given its wide range of manifestations and diagnostic testing can take days or longer. Here, we present a case of Lyme disease presenting as brachial plexopathy and meningitis. Patient concerns: A 76-years-old male presented to a tertiary-care hospital with left arm weakness and neck pain. Diagnosis: Our patient was diagnosed with Lyme neuroborreliosis and had positive serology, including enzyme immunoassay and Western blot. Interventions: Our patient received 17 days of ceftriaxone (2g IV daily) followed by oral doxycycline (100mg bid). Outcomes: Over the subsequent year, our patient had eventual complete recovery in muscle strength and sensation, with slower improvement to the cervical neck and left arm pain. Lessons: Incidence of Lyme disease is increasing in North America, and the disease has a wide range of symptoms. Lyme neuroborreliosis (LNB) is 1 presentation and can present with early or late manifestations; clinicians should maintain a high index of suspicion and begin empiric treatment in individuals with a clinical syndrome consistent with LNB. Early LNB manifestations have onset within 6 months of infection and include cranial and peripheral neuropathy, radiculitis, and aseptic meningitis; late LNB encompasses a chronic encephalomyelitis.