Findings and treatment of a rare case presentation of painful neuroborreliosis

Abstract

The painful component of Neuroborreliosis is potentially a severe and debilitating complication of Lyme disease and is thoroughly underreported in pain literature. Case reports of successful treatment of pain component are also not well described. We describe a rare case of painful Neuroborreliosis successfully treated with neuropathic agent gabapentin. A 68 y male in usual health with 4 weeks history of progressive torso numbness, paresthesias, back pain, and proximal leg weakness. Six weeks prior to admission, noted acute episode of interscapular back pain after golfing in CT, progressive to flanks, groin and lower extremities bilaterally. No documentation of tick bite. PO opioid rotation unsuccessful. Rapid progressive weakness to lower extremity paraplegia upon presentation to hospital. Full diagnostic work-up: positive confirmatory serum IgM and IgG Lyme Ab by Western Blot. Patient diagnosed with Neuroborreliosis; discharged home with 3 weeks IV ceftriaxone with full neurological resolution, however with remanent pain symptoms. Patient presents to Pain Center three weeks post discharge. Intense pins/needles sensation in T8-T12 dermatomal distribution with significant hyperhydrosis on affected dermatomes. Physical exam demonstrates thoracolumbar neuropathy secondary to recent history of Lyme disease with inflammatory radiculopathy. Given neuropathic model of pain, patient prescribed gabapentin. Within three weeks of escalating doses of gabapentin, patient's painful radiculitis completely resolved with total of 300mg BID dose. There is unclear mechanism of effects of Lyme disease on the nervous system, and particularly on dorsal column neurons. While case reports of neurologic sequelae of Lyme disease is plentiful in neurological literature, the painful syndromes and neuropathies that result are far more rare, and probably unknown to the pain physician. The use of gabapentin, even low dose, in this case shows very impressive result in treating painful Neuroborreliosis. (Halperin JJ. Curr Treat Options Neurol 2007.)