Lymphocytic meningoradiculitis of Bannwarth and erythema migrans disease.

Abstract

Dear Sir--Neurological manifestations associated with erythema migrans have been known in central and northern Europe for several decades. In 1922, Garin and Bujadoux published the case of a patient who developed a migrating erythema and meningoradiculitis after a tick bite [8]. However, the migrating erythema described was not recognised as erythema migrans, which had been known in the dermatological literature since 1910 [2]. In the early 1940s, Bannwarth gave a careful description of a series of patients with lymphocytic meningoradiculitis [3, 4]. Unfortunately, he missed the relation of the described syndrome to tick bite and erythema migrans, although at least two of his patients seemed to have had that skin condition. In the Scandinavian literature, however, the relationship of neurological symptoms to tick bite and/or erythema migrans was recognised in several case reports, first by Hellerstrrm in 1930 (cited in [12, 24]). In addition, Hollstrrm reported on the beneficial effect of penicillin in patients with erythema migrans and one patient with meningitis [11]. Hellerstrrm believed that an infectious agent with allergizing properties caused erythema migrans with or without meningitis. Because of the work of Lennhoff who claimed to have found spirochetes in a variety of skin disorders including erythema migrans, Hellerstrrm even mentioned spirochetes as a possible cause [10]. Despite these observations the general opinion favoured a viral origin of lymphocytic meningoradiculitis [14]. In 1974, I published the case of a patient whose erythema migrans disappeared after treatment with oral penicillin but the patient still developed meningitis. High doses of parenteral penicillin induced a dramatic beneficial response in this patient. I thought that erythema migrans and the accompanying meningitis were caused by one and the same unknown bacterium. Borrelia was one of the possibilities discussed [22]. Later, I postulated the persistence of the causative agent and suggested appropriate antibiotic therapy for later manifestations of erythema migrans and Lyme disease [23].