Tuesday, 3 April 2018

A Case of Post-Lyme Disease Syndrome (PLDS) Involving Motor Neuropathy and Myositis





A 53-year-old man presented with bilateral foot drop. His lower-extremity weakness predominantly affected the distal right limb. He presented hypercreatine kinasemia and high antibody titer for Borrelia species (spp). The nerve conduction study and needle electromyography suggested active neurogenic findings, indicating motor neuropathy. The gastrocnemius muscle biopsy showed scattered fiber necrosis and inflammatory cell infiltration, representing myositis. After administration of minocycline, Borrelia spp antibodies became negative. Symptoms gradually improved with repeated intravenous immunoglobulin administration. This is a very rare case of post-Lyme disease syndrome involving motor neuropathy and myositis, which represents an immune-mediated reaction to Borrelia spp infection.

Post-Lyme disease syndrome (PLDS) is characterized by chronic physical weariness, muscle pain, and neurological deficits, such as paresthesia and memory disturbance, after treatment with antibiotics. The diagnosis of chronic Lyme disease can predominantly be classified into four categories. PLDS is defined as a group of subjective symptoms such as paresthesia and memory disturbance that persist despite proper treatment of Borrelia burgdorferi infection. However, the pathogenesis of PLDS remains unknown. Some reports have described cases of PLDS associated with myositis and neuropathy. Thus,, patients with other conditions may be included. However, we provide the first report of chronic motor axonal neuropathy and myositis without acute symptoms of Lyme disease in a patient with PLDS.

A 53-year-old agricultural teacher who traveled frequently both overseas and domestically presented with bilateral foot drop. He had a history of hepatitis B and dengue fever infections. As his job involves teaching agriculture to the local people, he frequently went on walks in the forest, while wearing short pants, that is, with large areas of exposed skin. He visited many countries, including Sri Lanka and Pakistan. He had also visited many regions in Japan, particularly in Nagano and Hokkaido prefectures. Thus, his risk of exposure to tick bites was very high. He reported that he often felt feverish, but the fevers were not severe. He did not have other notable symptoms. 

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