Pseudotumor cerebri as the presentation of Lyme disease in a non-endemic area

Area of Science:

• Neurology
• Infectious Diseases
• Pediatrics

Background:

• Intracranial hypertension is uncommon in prepubertal children, with diverse potential causes including systemic diseases and deficiencies.
• Infectious etiologies for intracranial hypertension are rare, making diagnosis challenging.

Observation:

• A 9-year-old boy presented with symptoms of intracranial hypertension, including headaches, pallor, photophobia, and phonophobia.
• Neurological examination revealed papilledema, and lumbar puncture showed elevated cerebrospinal fluid (CSF) pressure with lymphocytic pleocytosis.
• Positive serum and CSF antibodies for *Borrelia burgdorferi* indicated acute neuroborreliosis.

Findings:

• The case highlights acute neuroborreliosis as a rare but significant cause of intracranial hypertension in a pediatric patient.
• A history of travel to an endemic area was a key factor in suspecting this infectious etiology.
• Inflammatory CSF findings combined with intracranial hypertension strongly suggested an infectious cause.

Implications:

• This case underscores the importance of considering infectious causes, specifically neuroborreliosis, in the differential diagnosis of pediatric intracranial hypertension.
• A thorough patient history, including travel and environmental exposures, is critical for identifying rare infectious triggers.
• Prompt diagnosis and targeted treatment are essential for managing intracranial hypertension secondary to neuroborreliosis and preventing long-term neurological sequelae.