Abstract

Back pain is a common symptom among patients presenting to the acute medical unit. We describe the case of a 55-year-old man with a brief history of fatigue and severe back pain, unresponsive to escalating doses of opiate analgesia. Blood tests and imaging studies were unremarkable and a functional diagnosis was considered. Several weeks into his admission he developed a lower motor neurone facial nerve palsy. He was treated with antibiotics for an incidental finding of a hospital-acquired pneumonia on imaging, which remarkably led to the resolution of his facial palsy and allowed a dramatic reduction in analgesia. This triggered further investigations; identifying Lyme neuroborreliosis as the cause of his symptoms.

[download-attachments container="div" style="list" display_icon="1" display_count="1" display__size="0"]

References

1. Stanek G, Wormser GP, Gray J et al. Lyme borreliosis. Lancet 2012; 379: 461–473.
2. Hansen K, Crone C, Kristoferitsch W. Chapter 32 – Lyme Neuroborreliosis. In: Handbook of Clinical Neurology. 2013. Vol 115 559–575.
3. Dryden MS, Saeed K, Ogborn S et al. Lyme borreliosis in Southern United Kingdom and a case for a new syndrome, chronic arthropod-borne neuropathy. Epidemiol Infect 2014; 9: 1–12.
4. Reimers CD, Neubert U. Garin-Bujadoux-Banwarth syndrome. Lancet 1990; 336: 128.
5. Pachner AR, Steiner I; Lyme neuroborreliosis: infection, immunity and inflammation. Lancet Neurol 2007; 6: 544–552.
6. Hansen K, Lebech AM. The clinical and epidemiological profile of Lyme neuroborreliosis in Denmark 1985–1990. A prospective study of 187 patients with Borrelia burgdorferi specific intrathecal antibody production. Brain 1992; 115: 399–423.
7. Steere AC, Sikand VK. The Presenting Manifestations of Lyme Disease and the Outcomes of Treatment. N Engl J Med 2003; 348: 2472–2474.
8. Faul JL, Doyle RL, Kao PN et al. Tick-Borne Pulmonary Disease – Update on Diagnosis and Management. Chest 1999; 116: 222–230.
9. Winter EM, Rothbarth PH, Delfos NM. Misleading presentation of acute Lyme Neuroborreliosis. BMJ Case Reports 2012.
10. Byrd RP, Vasquez J, Roy TM. Respiratory manifestations of tickborne diseases in the southern US. South Med J 1997; 90: 1–4.
11. Silva MT, Sophar M, Howard RS et al. Neuroborreliosis as a cause of respiratory failure. J Neurol 1995; 242: 604–607.
12. Soloski MJ, Crowder LA, Lahey L et al. Serum Inflammatory Mediators as Markers of Human Lyme Disease Activity. PLOS One 2014; 9.
13. Mygland A, Ljostad U, Fingerle V et al. EFNS guidelines on the diagnosis and management of European Lyme Neuroborreliosis. Eur J Neurol 2010; 17: 8.
14. Christen HJ, Hanefeld F, Eiffert H et al. Epidemiology and clinical manifestations of Lyme borreliosis in childhood. A prospective multicentre study with special regard to neuroborreliosis. Acta Paediatr Suppl 1993; 386: 1–75.
15. Cerar T, Ogrinc K, Cimperman J et al. Validation of cultivation and PCR methods for diagnosis of Lyme neuroborreliosis. J Clin Microbiol 2008; 46: 3375–3379.
16. Shadick NA, Phillips CB, Logigian EL et al. The Long-Term Clinical Outcomes of Lyme Disease: A Population-based Retrospective Cohort Study. Ann Intern Med 1994; 121: 560–567.