[Case of Borrelia brainstem encephalitis presenting with severe dysphagia].
We report the case of a 30-year-old man who developed severe dysphagia owing to neuroborreliosis. He showed dysphagia, diplopia, hiccups, and walking difficulty Neurological examination revealed mild disturbance of consciousness, diplopia on left lateral gaze, left-side-dominant blephaloptosis, gaze-evoked horizontal nystagmus on left lateral gaze, mild bilateral muscle weakness, palatoplegia, dysphagia, dysarthria, and truncal ataxia An increased pharyngeal reflex caused dysphagia in this patient. An EEG revealed intermittent high amplitude slow wave activity. However, head MRI, blood count, serum chemistry, and cerebrospinal fluid examination showed no abnormality. Initially, brainstem encephalitis with unknown etiology was diagnosed. The hiccups, diplopia, and ptosis were improved by corticosteroid therapy, but other symptoms were refractory to corticosteroid therapy and IVIg. After these immunotherapies, anti-Borrelia IgG and IgM antibodies were found to be positive, and symptoms, including dysphagia, were improved by doxycycline and cefotaxime. Because the clinical symptoms of Borrelia infection are widely variable, neuroborreliosis should be considered in patients with brainstem encephalitis refractory to conventional immunotherapies.
Kawano
Yuji
Y
Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University.
Shigeto
Hiroshi
H
Shiraishi
Yoshimasa
Y
Ohyagi
Yasumasa
Y
Kira
Jun-Ichi
J
D000328:Adult; D000907:Antibodies, Bacterial / Q000097:blood; D015748:Borrelia burgdorferi Group / Q000276:immunology; D001933:Brain Stem; D002439:Cefotaxime / Q000008:administration & dosage; D003680:Deglutition Disorders / Q000209:etiology*; D004318:Doxycycline / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D020852:Lyme Neuroborreliosis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D008297:Male; D012698:Serologic Tests; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000907:Antibodies, Bacterial; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D004318:Doxycycline; D002439:Cefotaxime