Neuroborreliosis as a Rare Cause of Myelitis in Childhood

Figure

Magnetic resonance imaging of the cervical spine showed myeloedema with longitudinal stripes of contrast medium enhancement

An 11-year-old girl presented with a 3-week history of pain and weakness in both arms. The proprioceptive reflexes and sensory perception were normal. Examination revealed a circular rash in the right armpit, but the patient had no memory of a tick bite.

Magnetic resonance imaging showed signal alterations with contrast medium uptake (C4 to T4) (Figure). A cerebrospinal fluid (CSF) sample revealed lymphocytic pleocytosis (260/µL) and a protein concentration of 194 mg/dL with normal glucose and lactate levels, as well as an albumin L/S ratio (x 1000) of 23.8 (normal range <5), indicating a barrier disorder. Moreover, the CSF analysis was positive for Borrelia burgdorferi (IgM antibodies 63 U/mL and IgG antibodies 1508 U/mL) with a positive immunoblot for IgM antibodies and borderline positive immunoblot for IgG antibodies. Serological examination showed elevated levels of IgG antibodies (49 U/mL) and negative IgM antibodies (17 U/mL) (normal range for both antibodies <25 U/mL). Treatment with cefotaxime, aciclovir (until a viral pathogenesis could be excluded), and immunoglobulin led to complete resolution of symptoms. Neuroborreliosis should be considered in the presence of myelitis of unclear origin.

Dr. med. Nasenien Nourkami-Tutdibi, Prof. Dr. med. Sascha Meyer, Universitätsklinikum des Saarlandes, Klinik für Allgemeine Pädiatrie und Neonatologie, Homburg, [e-mail]

Dr. med. Umut Yilmaz, Universitätsklinikum des Saarlandes, Abteilung für Neuroradiologie, Homburg

Conflict of interest statement: The authors declare that no conflict of interest exists.

Translated from the original German by David Roseveare.

Cite this as: Nourkami-Tutdibi N, Meyer S, Yilmaz U: Neuroborreliosis as a rare cause of myelitis in childhood. Dtsch Arztebl Int 2019; 116: 412. DOI: 10.3238/arztebl.2019.0412a