Lyme neuroborreliosis: An unusual case with extensive (peri) vasculitis of the middle cerebral artery

Palleis, Carla ; Forbrig, Robert; Lehner, Louisa; Quach, Stefanie; Albert, Nathalie L.; Brendel, Matthias; Schöberl, Florian und Straube, Andreas (2022): Lyme neuroborreliosis: An unusual case with extensive (peri) vasculitis of the middle cerebral artery. In: European Journal of Neurology, Bd. 30, Nr. 3: S. 785-787

Abstract

Lyme disease is a tick--borne infection caused by Borrelia burgdorferi sensu latu. Neuroborreliosis is reported in approximately 10% of patients with Lyme disease. We report a patient with central nervous system (CNS) large vessel vasculitis, ischemic stroke, and tumefactive contrast--enhancing brain lesions, an unusual complication of neuroborreliosis. A 56--year--old man presented with headache and disorientation for 1 month. Magnetic resonance imaging revealed basal meningitis with rapidly progressing frontotemporoinsular edema and (peri)vasculitis. Transcranial ultrasound confirmed stenosed medial cerebral arteries. [18F] GE--180 microglia positron emission tomography (PET) showed frontotemporoinsular signal more pronounced on the right. [18F]FET amino acid PET demonstrated low tracer uptake, suggesting an inflammatory process. Cerebrospinal fluid (CSF) showed lymphomonocytosis (243/mu l), intrathecal anti--Borrelia IgM (CSF/serum index = 15.65, normal <1.5) and anti-Borrelia IgG (CSF/serum index = 6.5, normal < 1.5), and elevated CXCL13 (29.2 pg/ml, normal < 10 pg/ml). Main differential diagnoses of neurotuberculosis and perivascular CNS lymphoma were ruled out by biopsy and Quantiferon enzyme--linked immunosorbent assay. Ceftriaxone (28days), cortisone, and nimodipine (3 months) led to full recovery. Neuroborreliosis is an important differential diagnosis in patients with CNS large vessel vasculitis and tumefactive contrast--enhancing brain lesions, mimicking perivascular CNS lymphoma or neurotuberculosis as main neuroradiological differential diagnoses. Vasculopathy and cerebrovascular events are rare in neuroborreliosis but should be considered, especially in endemic areas.

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin ; Medizin > Munich Cluster for Systems Neurology (SyNergy)
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 1351-5101
• Sprache: Englisch
• DFG: Gefördert durch die Deutsche Forschungsgemeinschaft (DFG) - 491502892
• DFG: Gefördert durch die Deutsche Forschungsgemeinschaft (DFG) - 390857198