TY - JOUR
T1 - Peripheral neuropathy due to neuroborreliosis
T2 - Insensitivity for CXCL13 as early diagnostic marker
AU - Gubanova, Kristina
AU - Lang, Julia
AU - Latzko, Juliane
AU - Novotna, Bianka
AU - Perneczky, Julian
AU - Pingitzer, Stefan
AU - Purer, Petra
AU - Wuchty, Bianca
AU - Waiß, Christoph
AU - Sellner, Johann
N1 - Publisher Copyright:
© 2021 The Author(s)
PY - 2021/4
Y1 - 2021/4
N2 - The case of a 69-year-old woman with peripheral neuropathy caused by Lyme neuroborreliosis (LNB) in an endemic region in Eastern Austria is reported. The patient had noticed transient numbness of her left leg. On initial examination, she had patchy sensory disturbances of the left lower leg, but ancillary examinations of nerve conduction and cerebrospinal fluid (CSF), including the B-cell chemokine CXCL13, were normal. A re-tap performed 54 days later, following clinical progression with foot drop, widespread lower leg paresthesia, and pain, revealed an increased cell count, autochthonous IgM production, synthesis of Borrelia-specific IgM, and elevated CXCL13. Neurophysiological examinations disclosed an incomplete conduction block, mixed axonal and demyelinating sensorimotor neuropathy, and subacute neurogenic damage of muscles innervated by the peroneal nerve. This case study presents rare evidence of very early diagnostic findings in peripheral neuropathy caused by LNB. These are characterized by insensitivity of CXCL13 in CSF to aid earlier diagnosis and the development of an intrathecal immune response against Borrelia at a later stage. These findings reinforce the need for a re-tap to confirm the diagnosis and facilitate appropriate treatment in this rare manifestation of LNB.
AB - The case of a 69-year-old woman with peripheral neuropathy caused by Lyme neuroborreliosis (LNB) in an endemic region in Eastern Austria is reported. The patient had noticed transient numbness of her left leg. On initial examination, she had patchy sensory disturbances of the left lower leg, but ancillary examinations of nerve conduction and cerebrospinal fluid (CSF), including the B-cell chemokine CXCL13, were normal. A re-tap performed 54 days later, following clinical progression with foot drop, widespread lower leg paresthesia, and pain, revealed an increased cell count, autochthonous IgM production, synthesis of Borrelia-specific IgM, and elevated CXCL13. Neurophysiological examinations disclosed an incomplete conduction block, mixed axonal and demyelinating sensorimotor neuropathy, and subacute neurogenic damage of muscles innervated by the peroneal nerve. This case study presents rare evidence of very early diagnostic findings in peripheral neuropathy caused by LNB. These are characterized by insensitivity of CXCL13 in CSF to aid earlier diagnosis and the development of an intrathecal immune response against Borrelia at a later stage. These findings reinforce the need for a re-tap to confirm the diagnosis and facilitate appropriate treatment in this rare manifestation of LNB.
KW - Aged
KW - Austria
KW - B-Lymphocytes/immunology
KW - Biomarkers/cerebrospinal fluid
KW - Borrelia/immunology
KW - Chemokine CXCL13/cerebrospinal fluid
KW - Female
KW - Humans
KW - Lyme Neuroborreliosis/complications
KW - Peripheral Nervous System Diseases/diagnosis
UR - http://www.scopus.com/inward/record.url?scp=85102804669&partnerID=8YFLogxK
U2 - 10.1016/j.ijid.2021.02.050
DO - 10.1016/j.ijid.2021.02.050
M3 - Journal article
C2 - 33684563
SN - 1201-9712
VL - 105
SP - 460
EP - 462
JO - International Journal of Infectious Diseases
JF - International Journal of Infectious Diseases
ER -