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Lyme disease meningopolyneuritis simulating malignant lymphoma
1Department of Pathology, Harvard Medical School, Boston, Massachusetts.
Summary
Lyme disease can mimic lymphoma in cerebrospinal fluid, presenting with unusual cells. Early immunocytochemical and serologic tests are crucial for accurate diagnosis and treatment of this tick-borne illness.
Area of Science:
- Neurology
- Infectious Diseases
- Cytopathology
Background:
- Lyme disease, caused by Borrelia burgdorferi, is a tick-borne illness with diverse symptoms.
- Neurologic Lyme disease can manifest as meningitis or Bannwarth's syndrome, sometimes without typical skin or tick exposure history.
- Cerebrospinal fluid (CSF) analysis is vital for diagnosing neurologic involvement.
Purpose of the Study:
- To describe the cytomorphologic and immunocytochemical features of CSF in Lyme disease patients presenting with isolated neurologic symptoms.
- To highlight the potential for misdiagnosis of CSF findings as malignant lymphoma.
- To emphasize the importance of specific diagnostic tests for Lyme disease.
Main Methods:
- Analysis of cerebrospinal fluid (CSF) cytomorphology and immunocytochemistry.
- Review of clinical history and peripheral blood serologic testing for Borrelia burgdorferi antibodies.
- Case series of four patients with isolated neurologic symptoms.
Main Results:
- CSF revealed atypical plasmacytoid mononuclear cells, initially suggestive of lymphoma.
- Immunocytochemistry demonstrated polyclonal surface immunoglobulin, indicating an inflammatory process.
- All four patients were ultimately diagnosed with Lyme disease via serology and clinical follow-up.
Conclusions:
- Lyme disease can present with CSF lymphoplasmacytic infiltrates that mimic malignant lymphoma.
- Immunocytochemical studies and serologic testing are essential to differentiate Lyme disease from lymphoma.
- Accurate diagnosis is critical for appropriate treatment of neurologic Lyme disease.