Neuroborreliosis presenting as acute disseminated encephalomyelitis

Area of Science:

• Pediatric Neurology
• Infectious Diseases
• Neuroimmunology

Background:

• Neuroborreliosis, a Lyme disease manifestation, can present with diverse neurological symptoms.
• Acute disseminated encephalomyelitis (ADEM) is an immune-mediated inflammatory demyelinating disease of the central nervous system.
• Early recognition of neuroborreliosis is critical, as it can mimic other neurological conditions.

Observation:

• A 5-year-old boy presented with acute encephalopathy, facial palsy, and seizures following an upper-airway infection.
• Neurological examination revealed hypotonia, ataxia, dysarthria, and impaired gag/cough reflexes post-mechanical ventilation.
• Brain MRI demonstrated hyperintense lesions in the occipital, parietal, internal capsule, and medulla oblongata.

Findings:

• Polymerase chain reaction (PCR) and Western blotting confirmed Borrelia burgdorferi infection in plasma and cerebrospinal fluid.
• The clinical presentation and MRI findings were consistent with acute disseminated encephalomyelitis as an initial manifestation of neuroborreliosis.
• Diagnosis was supported by laboratory confirmation of Borrelia burgdorferi infection.

Implications:

• This case highlights the importance of considering neuroborreliosis in children presenting with ADEM-like symptoms, especially after potential tick exposure or in endemic areas.
• Prompt antibiotic treatment (ceftriaxone) alongside immunomodulatory therapy (methylprednisolone, immunoglobulin) is essential for managing severe neuroborreliosis.
• Despite treatment, partial neurological recovery underscores the potential for long-term sequelae in pediatric neuroborreliosis, necessitating further research into optimal management strategies.