title: Neuroborreliosis presenting as acute disseminated encephalomyelitis.
abstract: We report a case of a 5-year-old boy with acute disseminated encephalomyelitis as the initial presentation of neuroborreliosis. Parents report an upper-airway infection a few days before the development of acute encephalopathy, mild facial palsy, and seizures. The patient needed mechanical ventilation for 10 days, and after extubation, he presented hypotonia, ataxia, dysarthria, as well as weak gag and cough reflexes. Brain magnetic resonance imaging showed hyperintense lesions on T2- and fluid-attenuated inversion recovery sequences on the right subcortical occipital and parietal region, left posterior arm of the internal capsule, and in the medulla oblongata. Borrelia burgdorferi was identified in the plasma and cerebrospinal fluid by polymerase chain reaction and in the plasma by Western blotting. He was treated with ceftriaxone, methylprednisolone, and human immunoglobulin. Recovery was partial.
authors.affiliation: Pediatric Intensive Care Unit, Centro Hospitalar S João, Porto, Portugal.
authors.forename: Ruben
authors.initials: R
authors.lastname: Rocha
authors.forename: Lurdes
authors.initials: L
authors.lastname: Lisboa
authors.forename: João
authors.initials: J
authors.lastname: Neves
authors.forename: Milagros
authors.initials: M
authors.lastname: García López
authors.forename: Elsa
authors.initials: E
authors.lastname: Santos
authors.forename: Augusto
authors.initials: A
authors.lastname: Ribeiro
mesh_terms: D001925:Brain Damage, Chronic / Q000209:etiology; D002439:Cefotaxime / Q000627:therapeutic use; D002443:Ceftriaxone / Q000627:therapeutic use; D002675:Child, Preschool; D003128:Coma / Q000209:etiology; D003975:Diazepam / Q000627:therapeutic use; D004673:Encephalomyelitis, Acute Disseminated / Q000209:etiology*; D005158:Facial Paralysis / Q000209:etiology; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D020852:Lyme Neuroborreliosis / Q000150:complications / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging; D008297:Male; D008417:Mastoiditis / Q000150:complications; D008775:Methylprednisolone / Q000627:therapeutic use; D011174:Portugal; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy; D012141:Respiratory Tract Infections / Q000150:complications; D012640:Seizures / Q000188:drug therapy / Q000209:etiology; D012852:Sinusitis / Q000150:complications; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D016756:Immunoglobulins, Intravenous; D014640:Vancomycin; D002443:Ceftriaxone; D002439:Cefotaxime; D003975:Diazepam; D008775:Methylprednisolone