DÄ internationalArchive23-24/2019Neuroborreliosis as a Rare Cause of Myelitis in Childhood

Clinical Snapshot

Neuroborreliosis as a Rare Cause of Myelitis in Childhood

Dtsch Arztebl Int 2019; 116: 412. DOI: 10.3238/arztebl.2019.0412a

Nourkami-Tutdibi, N; Meyer, S; Yilmaz, U

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Magnetic resonance imaging of the cervical spine showed myeloedema with longitudinal stripes of contrast medium enhancement
Magnetic resonance imaging of the cervical spine showed myeloedema with longitudinal stripes of contrast medium enhancement
Figure
Magnetic resonance imaging of the cervical spine showed myeloedema with longitudinal stripes of contrast medium enhancement

An 11-year-old girl presented with a 3-week history of pain and weakness in both arms. The proprioceptive reflexes and sensory perception were normal. Examination revealed a circular rash in the right armpit, but the patient had no memory of a tick bite.

Magnetic resonance imaging showed signal alterations with contrast medium uptake (C4 to T4) (Figure). A cerebrospinal fluid (CSF) sample revealed lymphocytic pleocytosis (260/µL) and a protein concentration of 194 mg/dL with normal glucose and lactate levels, as well as an albumin L/S ratio (x 1000) of 23.8 (normal range <5), indicating a barrier disorder. Moreover, the CSF analysis was positive for Borrelia burgdorferi (IgM antibodies 63 U/mL and IgG antibodies 1508 U/mL) with a positive immunoblot for IgM antibodies and borderline positive immunoblot for IgG antibodies. Serological examination showed elevated levels of IgG antibodies (49 U/mL) and negative IgM antibodies (17 U/mL) (normal range for both antibodies <25 U/mL). Treatment with cefotaxime, aciclovir (until a viral pathogenesis could be excluded), and immunoglobulin led to complete resolution of symptoms. Neuroborreliosis should be considered in the presence of myelitis of unclear origin.

Dr. med. Nasenien Nourkami-Tutdibi, Prof. Dr. med. Sascha Meyer, Universitätsklinikum des Saarlandes, Klinik für Allgemeine Pädiatrie und Neonatologie, Homburg, Nasenien.Nourkami@uks.eu

Dr. med. Umut Yilmaz, Universitätsklinikum des Saarlandes, Abteilung für Neuroradiologie, Homburg

Conflict of interest statement: The authors declare that no conflict of interest exists.

Translated from the original German by David Roseveare.

Cite this as: Nourkami-Tutdibi N, Meyer S, Yilmaz U: Neuroborreliosis as a rare cause of myelitis in childhood. Dtsch Arztebl Int 2019; 116: 412. DOI: 10.3238/arztebl.2019.0412a

Magnetic resonance imaging of the cervical spine showed myeloedema with longitudinal stripes of contrast medium enhancement
Magnetic resonance imaging of the cervical spine showed myeloedema with longitudinal stripes of contrast medium enhancement
Figure
Magnetic resonance imaging of the cervical spine showed myeloedema with longitudinal stripes of contrast medium enhancement