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A unique case of adolescent neuroborreliosis presenting with multiple cranial neuritis and cochlear inflammation on magnetic resonance imaging.
Pediatr Neurol 2015; 52(1):107-9PN

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.

PATIENT DESCRIPTION

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.

DISCUSSION

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+Show Affiliations

Department of Medicine, Tripler Army Medical Center, Honolulu, Hawaii. Electronic address: evan.c.ewers.mil@mail.mil.Department of Neurology, Walter Reed National Military Medical Center, Bethesda, Maryland.Pediatric Infectious Diseases, Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, Maryland.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

25459362

Citation

Ewers, Evan C., et al. "A Unique Case of Adolescent Neuroborreliosis Presenting With Multiple Cranial Neuritis and Cochlear Inflammation On Magnetic Resonance Imaging." Pediatric Neurology, vol. 52, no. 1, 2015, pp. 107-9.
Ewers EC, Dennison DH, Stagliano DR. A unique case of adolescent neuroborreliosis presenting with multiple cranial neuritis and cochlear inflammation on magnetic resonance imaging. Pediatr Neurol. 2015;52(1):107-9.
Ewers, E. C., Dennison, D. H., & Stagliano, D. R. (2015). A unique case of adolescent neuroborreliosis presenting with multiple cranial neuritis and cochlear inflammation on magnetic resonance imaging. Pediatric Neurology, 52(1), pp. 107-9. doi:10.1016/j.pediatrneurol.2014.10.009.
Ewers EC, Dennison DH, Stagliano DR. A Unique Case of Adolescent Neuroborreliosis Presenting With Multiple Cranial Neuritis and Cochlear Inflammation On Magnetic Resonance Imaging. Pediatr Neurol. 2015;52(1):107-9. PubMed PMID: 25459362.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A unique case of adolescent neuroborreliosis presenting with multiple cranial neuritis and cochlear inflammation on magnetic resonance imaging. AU - Ewers,Evan C, AU - Dennison,David H, AU - Stagliano,David R, Y1 - 2014/10/16/ PY - 2014/08/05/received PY - 2014/10/08/revised PY - 2014/10/09/accepted PY - 2014/12/3/entrez PY - 2014/12/3/pubmed PY - 2015/8/25/medline KW - Bannwarth syndrome KW - Lyme disease KW - cochleitis KW - hearing loss KW - neuroborreliosis SP - 107 EP - 9 JF - Pediatric neurology JO - Pediatr. Neurol. VL - 52 IS - 1 N2 - 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. PATIENT DESCRIPTION: 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. DISCUSSION: 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. SN - 1873-5150 UR - https://www.unboundmedicine.com/medline/citation/25459362/A_unique_case_of_adolescent_neuroborreliosis_presenting_with_multiple_cranial_neuritis_and_cochlear_inflammation_on_magnetic_resonance_imaging L2 - https://linkinghub.elsevier.com/retrieve/pii/S0887-8994(14)00607-9 DB - PRIME DP - Unbound Medicine ER -