F56. Description of neurophysiological findings in mononeuritis multiple as a neurologic manifestation of borrelia burgdorferi infection - Case report

Abstract

Introduction The infection for Borrelia burgdorferi is a zoonosis, in which the spirochaetes can be transmitted to human beings only by the bite of infected ixodid ticks, the spirochaete is maintained at high levels in populations of field mice or birds, the likelihood of having it is dependent on geography, recreational habits of the patient, and season. It is a multisistemic disease it can affect central nervous system. Neurological manifestations often referred to as Lyme neuroborreliosis are reported in up to 12% of patients with Lyme disease. In Europe and the United States seroprevalencia is 1–27%. This has not been determined in Mexico yet. In Mexico are few reports and series of cases published about Lyme neuroborreliosis, being a subdiagnosed disease in patients with neurological clinical manifestations. Methods Male 23 yo, carpenter. He started eight months earlier with symmetric paresthesias of both hands with ascending distribution from distal to proximal, presented inability to hold work tools with both hands, paresthesias in the plantar region and paresis of the lower limbs, ascending from distal to proximal, preventing him from walking and requiring help, finally prostration. PE: Generalized atrophy of distal predominance, interosseous atrophy of thenar and hypothenar, proximal upper limb 4/5, distal 3/5, proximal and distal lower limbs 4/5, absent bilateral patellar reflex. Bilateral plantar flexor response. Hypopallesthesia, altered arthrokinesia in both lower limbs and right hand. Unsteady gait with a broad base, short and slow steps with help. Romberg positive. Results Neurophysiological studies. Somatosensory evoked potentials (SSEP) of upper limbs with peripheral response integration at the level of the brachial plexus (N9) asymmetric by left prolongation and absence of responses from posterior cords (N13). SSEP of lower limbs with complete and bilateral absence of responses from popliteal fossa. N. median left, N. ulnar right, delay in nerve conduction velocity. Bilateral tibial with prolonged latency. N. median left with prolongation of peak latency. N. ulnar voltage asymmetry by right depression. F response of bilateral ulnar nerve did not elicit response. Bilateral tibial nerve with prolonged latencies and frequency of reduced evocation. The neurophysiological study showed evidence of multiple mononeuropathy that involves all four limbs asymmetrically. Ig G by Western blot versus Borrelia burgdorferi was positive in blood. It was prescribed ceftriaxone 1 g IV BID for 14 days, after this treatment showed neurological improvement, he continued with doxycycline 100 mg orally BID for a month. Conclusion Neuropathies in patients with chronic Lyme disease commonly present as non-vasculitic multiple mononeuritis, the motor deficit follows the multiple pattern. This case is based on an unusual neurological manifestation together with the exclusive predilection for affection of the central nervous system, having as main geographical and occupational risk factors.