title: A unique case of adolescent neuroborreliosis presenting with multiple cranial neuritis and cochlear inflammation on magnetic resonance imaging.
abstract: BACKGROUND
  Lyme disease is the most common vector-borne disease in the United States and is caused by infection with the spirochete Borrelia burgdorferi. In children, neuroborreliosis usually presents as peripheral facial nerve palsy and lymphocytic meningitis and only rarely is associated with cranial polyneuritis.
  
  
  METHODS
  We present a 15-year-old with tinnitus, hearing loss, and facial nerve palsy in the setting of acute, severe right arm pain and a several week history of malaise and headache. Lumbar puncture was notable for lymphocytic pleocytosis. Serologic testing demonstrated positive Lyme antibody and a positive immunoglobulin M Western blot. Immunofluorescent assay of cerebrospinal fluid was also positive for anti-Lyme immunoglobulin M. Audiologic testing revealed mixed, right-sided hearing loss. Neuroimaging demonstrated cranial polyneuritis and right-sided cochlear inflammation. The patient was treated with parenteral ceftriaxone with resolution of his symptoms at close follow-up.
  
  
  CONCLUSIONS
  Neuroborreliosis with radiculopathy, lymphocytic meningitis, and cranial polyneuritis is a rare presentation of pediatric Lyme disease. Additionally, cochlear inflammation along with cranial nerve VIII inflammation may contribute to hearing loss in patients with neuroborreliosis.
authors.affiliation: Department of Medicine, Tripler Army Medical Center, Honolulu, Hawaii. Electronic address: evan.c.ewers.mil@mail.mil.
authors.forename: Evan C
authors.initials: EC
authors.lastname: Ewers
authors.affiliation: Department of Neurology, Walter Reed National Military Medical Center, Bethesda, Maryland.
authors.forename: David H
authors.initials: DH
authors.lastname: Dennison
authors.affiliation: Pediatric Infectious Diseases, Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, Maryland.
authors.forename: David R
authors.initials: DR
authors.lastname: Stagliano
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002443:Ceftriaxone / Q000627:therapeutic use; D015834:Cochlear Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology* / Q000503:physiopathology*; D003389:Cranial Nerve Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology* / Q000503:physiopathology*; D003937:Diagnosis, Differential; D005500:Follow-Up Studies; D006801:Humans; D020852:Lyme Neuroborreliosis / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology* / Q000503:physiopathology*; D008279:Magnetic Resonance Imaging; D008297:Male
chemical_list: D000900:Anti-Bacterial Agents; D002443:Ceftriaxone
keywords: Bannwarth syndrome; Lyme disease; cochleitis; hearing loss; neuroborreliosis