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Lyme neuroborreliosis in a critically ill patient

1 Department of Physical and Rehabilitation Medicine, University Hospital Center of São João, Porto, Portugal
2 Department of Neurology, University Hospital Center of São João; Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal
3 Department of Infectious Diseases, University Hospital Center of São João, Porto, Portugal

Correspondence Address:
Rui Alexandre Do Prado Costa,
Serviço de Medicina Física e de Reabilitação, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jisprm.jisprm_16_20

Lyme neuroborreliosis (LNB) is a nervous system infection caused by the species of the spirochete Borrelia. A woman, with a history of right facial palsy, was admitted to the physical and rehabilitation medicine (PRM) unit for the rehabilitation of presumed sequalae of aneurism rupture and neuromuscular weakness related to critical illness. She presented in the PRM unit with flaccid quadriparesis, right facial nerve paresis, bulbar paresis, aphonia, dysphagia, and hypoactive deep-tendon reflexes. Electromyography (EMG) revealed multifocal neuropathy and serologic tests revealed positive for Borrelia (IgG). The patient was treated with 2 weeks of intravenous ceftriaxone with a marked improvement in the following days. LNB diagnosis was made due to the clinical presentation, positive Borrelia serology, and great improvement with targeted therapy. Neuromuscular weakness related to critical illness was the main differential diagnosis; however, weakness in bulbar and facial musculature and the EMG findings were not consistent with this diagnosis.

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    -  Costa RA
    -  Pinto MJ
    -  Ruas JR
    -  Pinto NC
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