Lyme neuroborreliosis: An unusual case with extensive (peri)vasculitis of the middle cerebral artery
Lyme disease is a tick‐borne infection caused by Borrelia burgdorferi sensu latu. Neuroborreliosis is reported in approximately 10% of patients with Lyme disease. We report a patient with central nervous system (CNS) large vessel vasculitis, ischemic stroke, and tumefactive contrast‐enhancing brain...
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| Veröffentlicht in: | European journal of neurology 2023-03, Vol.30 (3), p.785-787 |
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| container_title | European journal of neurology |
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| creator | Palleis, Carla Forbrig, Robert Lehner, Louisa Quach, Stefanie Albert, Nathalie L. Brendel, Matthias Schöberl, Florian Straube, Andreas |
| description | Lyme disease is a tick‐borne infection caused by Borrelia burgdorferi sensu latu. Neuroborreliosis is reported in approximately 10% of patients with Lyme disease. We report a patient with central nervous system (CNS) large vessel vasculitis, ischemic stroke, and tumefactive contrast‐enhancing brain lesions, an unusual complication of neuroborreliosis. A 56‐year‐old man presented with headache and disorientation for 1 month. Magnetic resonance imaging revealed basal meningitis with rapidly progressing frontotemporoinsular edema and (peri)vasculitis. Transcranial ultrasound confirmed stenosed medial cerebral arteries. [18F]GE‐180 microglia positron emission tomography (PET) showed frontotemporoinsular signal more pronounced on the right. [18F]FET amino acid PET demonstrated low tracer uptake, suggesting an inflammatory process. Cerebrospinal fluid (CSF) showed lymphomonocytosis (243/μl), intrathecal anti‐Borrelia IgM (CSF/serum index = 15.65, normal |
| doi_str_mv | 10.1111/ene.15633 |
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Neuroborreliosis is reported in approximately 10% of patients with Lyme disease. We report a patient with central nervous system (CNS) large vessel vasculitis, ischemic stroke, and tumefactive contrast‐enhancing brain lesions, an unusual complication of neuroborreliosis. A 56‐year‐old man presented with headache and disorientation for 1 month. Magnetic resonance imaging revealed basal meningitis with rapidly progressing frontotemporoinsular edema and (peri)vasculitis. Transcranial ultrasound confirmed stenosed medial cerebral arteries. [18F]GE‐180 microglia positron emission tomography (PET) showed frontotemporoinsular signal more pronounced on the right. [18F]FET amino acid PET demonstrated low tracer uptake, suggesting an inflammatory process. Cerebrospinal fluid (CSF) showed lymphomonocytosis (243/μl), intrathecal anti‐Borrelia IgM (CSF/serum index = 15.65, normal < 1.5) and anti‐Borrelia IgG (CSF/serum index = 6.5, normal < 1.5), and elevated CXCL13 (29.2 pg/ml, normal < 10 pg/ml). Main differential diagnoses of neurotuberculosis and perivascular CNS lymphoma were ruled out by biopsy and Quantiferon enzyme‐linked immunosorbent assay. Ceftriaxone (28 days), cortisone, and nimodipine (3 months) led to full recovery. Neuroborreliosis is an important differential diagnosis in patients with CNS large vessel vasculitis and tumefactive contrast‐enhancing brain lesions, mimicking perivascular CNS lymphoma or neurotuberculosis as main neuroradiological differential diagnoses. Vasculopathy and cerebrovascular events are rare in neuroborreliosis but should be considered, especially in endemic areas.</description><identifier>ISSN: 1351-5101</identifier><identifier>EISSN: 1468-1331</identifier><identifier>DOI: 10.1111/ene.15633</identifier><identifier>PMID: 36636924</identifier><language>eng</language><publisher>England: John Wiley & Sons, Inc</publisher><subject>Amino acids ; Arteries ; Biopsy ; Borrelia ; Borreliosis ; Brain ; Ceftriaxone ; Central nervous system ; Cerebrospinal fluid ; CNS vasculitis ; Cortisone ; CXCL13 protein ; Differential diagnosis ; Disorientation ; Edema ; Fluorine isotopes ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Inflammation ; Ischemia ; Lesions ; Lyme disease ; Lyme Neuroborreliosis - cerebrospinal fluid ; Lyme Neuroborreliosis - complications ; Lyme Neuroborreliosis - diagnosis ; Lymphoma ; Lymphoma - complications ; Magnetic resonance imaging ; Male ; Meningitis ; Microglia ; Middle Aged ; Middle Cerebral Artery ; Nervous System Diseases ; neuroborreliosis ; Neuroimaging ; Nimodipine ; Positron emission ; Positron emission tomography ; Vascular diseases ; Vasculitis ; Vasculitis - complications ; Vector-borne diseases</subject><ispartof>European journal of neurology, 2023-03, Vol.30 (3), p.785-787</ispartof><rights>2022 The Authors. published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.</rights><rights>2022 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.</rights><rights>2022. This article is published under http://creativecommons.org/licenses/by-nc-nd/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3553-2e0dccc67987cf67ca51b082565d385531721df6d210490601d1a7a34f358c323</citedby><cites>FETCH-LOGICAL-c3553-2e0dccc67987cf67ca51b082565d385531721df6d210490601d1a7a34f358c323</cites><orcidid>0000-0002-4331-8145</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fene.15633$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fene.15633$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,1411,27903,27904,45553,45554</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36636924$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Palleis, Carla</creatorcontrib><creatorcontrib>Forbrig, Robert</creatorcontrib><creatorcontrib>Lehner, Louisa</creatorcontrib><creatorcontrib>Quach, Stefanie</creatorcontrib><creatorcontrib>Albert, Nathalie L.</creatorcontrib><creatorcontrib>Brendel, Matthias</creatorcontrib><creatorcontrib>Schöberl, Florian</creatorcontrib><creatorcontrib>Straube, Andreas</creatorcontrib><title>Lyme neuroborreliosis: An unusual case with extensive (peri)vasculitis of the middle cerebral artery</title><title>European journal of neurology</title><addtitle>Eur J Neurol</addtitle><description>Lyme disease is a tick‐borne infection caused by Borrelia burgdorferi sensu latu. Neuroborreliosis is reported in approximately 10% of patients with Lyme disease. We report a patient with central nervous system (CNS) large vessel vasculitis, ischemic stroke, and tumefactive contrast‐enhancing brain lesions, an unusual complication of neuroborreliosis. A 56‐year‐old man presented with headache and disorientation for 1 month. Magnetic resonance imaging revealed basal meningitis with rapidly progressing frontotemporoinsular edema and (peri)vasculitis. Transcranial ultrasound confirmed stenosed medial cerebral arteries. [18F]GE‐180 microglia positron emission tomography (PET) showed frontotemporoinsular signal more pronounced on the right. [18F]FET amino acid PET demonstrated low tracer uptake, suggesting an inflammatory process. Cerebrospinal fluid (CSF) showed lymphomonocytosis (243/μl), intrathecal anti‐Borrelia IgM (CSF/serum index = 15.65, normal < 1.5) and anti‐Borrelia IgG (CSF/serum index = 6.5, normal < 1.5), and elevated CXCL13 (29.2 pg/ml, normal < 10 pg/ml). Main differential diagnoses of neurotuberculosis and perivascular CNS lymphoma were ruled out by biopsy and Quantiferon enzyme‐linked immunosorbent assay. Ceftriaxone (28 days), cortisone, and nimodipine (3 months) led to full recovery. Neuroborreliosis is an important differential diagnosis in patients with CNS large vessel vasculitis and tumefactive contrast‐enhancing brain lesions, mimicking perivascular CNS lymphoma or neurotuberculosis as main neuroradiological differential diagnoses. Vasculopathy and cerebrovascular events are rare in neuroborreliosis but should be considered, especially in endemic areas.</description><subject>Amino acids</subject><subject>Arteries</subject><subject>Biopsy</subject><subject>Borrelia</subject><subject>Borreliosis</subject><subject>Brain</subject><subject>Ceftriaxone</subject><subject>Central nervous system</subject><subject>Cerebrospinal fluid</subject><subject>CNS vasculitis</subject><subject>Cortisone</subject><subject>CXCL13 protein</subject><subject>Differential diagnosis</subject><subject>Disorientation</subject><subject>Edema</subject><subject>Fluorine isotopes</subject><subject>Humans</subject><subject>Immunoglobulin G</subject><subject>Immunoglobulin M</subject><subject>Inflammation</subject><subject>Ischemia</subject><subject>Lesions</subject><subject>Lyme disease</subject><subject>Lyme Neuroborreliosis - cerebrospinal fluid</subject><subject>Lyme Neuroborreliosis - complications</subject><subject>Lyme Neuroborreliosis - diagnosis</subject><subject>Lymphoma</subject><subject>Lymphoma - complications</subject><subject>Magnetic resonance imaging</subject><subject>Male</subject><subject>Meningitis</subject><subject>Microglia</subject><subject>Middle Aged</subject><subject>Middle Cerebral Artery</subject><subject>Nervous System Diseases</subject><subject>neuroborreliosis</subject><subject>Neuroimaging</subject><subject>Nimodipine</subject><subject>Positron emission</subject><subject>Positron emission tomography</subject><subject>Vascular diseases</subject><subject>Vasculitis</subject><subject>Vasculitis - complications</subject><subject>Vector-borne diseases</subject><issn>1351-5101</issn><issn>1468-1331</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>WIN</sourceid><sourceid>EIF</sourceid><recordid>eNp1kD1PwzAQQC0EonwN_AFkiYUOoT47dlK2CpUPqYIF5sixL8JVmhQ7AfLvMQTY8HIe3r2THiGnwC4hvhk2eAlSCbFDDiBVeQJCwG78CwmJBAYTchjCmjHGM872yUQoJdScpwfEroYN0gZ735at91i7NrhwRRcN7Zs-9LqmRgek7657ofjRYRPcG9KLLXo3fdPB9LXrXKBtRbsXpBtnbY3UoMfSx13tO_TDMdmrdB3w5Gcekeeb5dP1XbJ6vL2_XqwSI6QUCUdmjTEqm-eZqVRmtISS5VwqaUUeCcg42EpZDiydM8XAgs60SCshcyO4OCLno3fr29ceQ1es29438WTBsywFKVmuIjUdKePbEDxWxda7jfZDAaz46lnEnsV3z8ie_Rj7coP2j_wNGIHZCLy7Gof_TcXyYTkqPwHEI35-</recordid><startdate>202303</startdate><enddate>202303</enddate><creator>Palleis, Carla</creator><creator>Forbrig, Robert</creator><creator>Lehner, Louisa</creator><creator>Quach, Stefanie</creator><creator>Albert, Nathalie L.</creator><creator>Brendel, Matthias</creator><creator>Schöberl, Florian</creator><creator>Straube, Andreas</creator><general>John Wiley & Sons, Inc</general><scope>24P</scope><scope>WIN</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TK</scope><scope>7U7</scope><scope>C1K</scope><scope>K9.</scope><orcidid>https://orcid.org/0000-0002-4331-8145</orcidid></search><sort><creationdate>202303</creationdate><title>Lyme neuroborreliosis: An unusual case with extensive (peri)vasculitis of the middle cerebral artery</title><author>Palleis, Carla ; Forbrig, Robert ; Lehner, Louisa ; Quach, Stefanie ; Albert, Nathalie L. ; Brendel, Matthias ; Schöberl, Florian ; Straube, Andreas</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3553-2e0dccc67987cf67ca51b082565d385531721df6d210490601d1a7a34f358c323</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Amino acids</topic><topic>Arteries</topic><topic>Biopsy</topic><topic>Borrelia</topic><topic>Borreliosis</topic><topic>Brain</topic><topic>Ceftriaxone</topic><topic>Central nervous system</topic><topic>Cerebrospinal fluid</topic><topic>CNS vasculitis</topic><topic>Cortisone</topic><topic>CXCL13 protein</topic><topic>Differential diagnosis</topic><topic>Disorientation</topic><topic>Edema</topic><topic>Fluorine isotopes</topic><topic>Humans</topic><topic>Immunoglobulin G</topic><topic>Immunoglobulin M</topic><topic>Inflammation</topic><topic>Ischemia</topic><topic>Lesions</topic><topic>Lyme disease</topic><topic>Lyme Neuroborreliosis - cerebrospinal fluid</topic><topic>Lyme Neuroborreliosis - complications</topic><topic>Lyme Neuroborreliosis - diagnosis</topic><topic>Lymphoma</topic><topic>Lymphoma - complications</topic><topic>Magnetic resonance imaging</topic><topic>Male</topic><topic>Meningitis</topic><topic>Microglia</topic><topic>Middle Aged</topic><topic>Middle Cerebral Artery</topic><topic>Nervous System Diseases</topic><topic>neuroborreliosis</topic><topic>Neuroimaging</topic><topic>Nimodipine</topic><topic>Positron emission</topic><topic>Positron emission tomography</topic><topic>Vascular diseases</topic><topic>Vasculitis</topic><topic>Vasculitis - complications</topic><topic>Vector-borne diseases</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Palleis, Carla</creatorcontrib><creatorcontrib>Forbrig, Robert</creatorcontrib><creatorcontrib>Lehner, Louisa</creatorcontrib><creatorcontrib>Quach, Stefanie</creatorcontrib><creatorcontrib>Albert, Nathalie L.</creatorcontrib><creatorcontrib>Brendel, Matthias</creatorcontrib><creatorcontrib>Schöberl, Florian</creatorcontrib><creatorcontrib>Straube, Andreas</creatorcontrib><collection>Wiley Online Library Open Access</collection><collection>Wiley Free Content</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Neurosciences Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><jtitle>European journal of neurology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Palleis, Carla</au><au>Forbrig, Robert</au><au>Lehner, Louisa</au><au>Quach, Stefanie</au><au>Albert, Nathalie L.</au><au>Brendel, Matthias</au><au>Schöberl, Florian</au><au>Straube, Andreas</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Lyme neuroborreliosis: An unusual case with extensive (peri)vasculitis of the middle cerebral artery</atitle><jtitle>European journal of neurology</jtitle><addtitle>Eur J Neurol</addtitle><date>2023-03</date><risdate>2023</risdate><volume>30</volume><issue>3</issue><spage>785</spage><epage>787</epage><pages>785-787</pages><issn>1351-5101</issn><eissn>1468-1331</eissn><abstract>Lyme disease is a tick‐borne infection caused by Borrelia burgdorferi sensu latu. Neuroborreliosis is reported in approximately 10% of patients with Lyme disease. We report a patient with central nervous system (CNS) large vessel vasculitis, ischemic stroke, and tumefactive contrast‐enhancing brain lesions, an unusual complication of neuroborreliosis. A 56‐year‐old man presented with headache and disorientation for 1 month. Magnetic resonance imaging revealed basal meningitis with rapidly progressing frontotemporoinsular edema and (peri)vasculitis. Transcranial ultrasound confirmed stenosed medial cerebral arteries. [18F]GE‐180 microglia positron emission tomography (PET) showed frontotemporoinsular signal more pronounced on the right. [18F]FET amino acid PET demonstrated low tracer uptake, suggesting an inflammatory process. Cerebrospinal fluid (CSF) showed lymphomonocytosis (243/μl), intrathecal anti‐Borrelia IgM (CSF/serum index = 15.65, normal < 1.5) and anti‐Borrelia IgG (CSF/serum index = 6.5, normal < 1.5), and elevated CXCL13 (29.2 pg/ml, normal < 10 pg/ml). Main differential diagnoses of neurotuberculosis and perivascular CNS lymphoma were ruled out by biopsy and Quantiferon enzyme‐linked immunosorbent assay. Ceftriaxone (28 days), cortisone, and nimodipine (3 months) led to full recovery. Neuroborreliosis is an important differential diagnosis in patients with CNS large vessel vasculitis and tumefactive contrast‐enhancing brain lesions, mimicking perivascular CNS lymphoma or neurotuberculosis as main neuroradiological differential diagnoses. Vasculopathy and cerebrovascular events are rare in neuroborreliosis but should be considered, especially in endemic areas.</abstract><cop>England</cop><pub>John Wiley & Sons, Inc</pub><pmid>36636924</pmid><doi>10.1111/ene.15633</doi><tpages>3</tpages><orcidid>https://orcid.org/0000-0002-4331-8145</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Amino acids Arteries Biopsy Borrelia Borreliosis Brain Ceftriaxone Central nervous system Cerebrospinal fluid CNS vasculitis Cortisone CXCL13 protein Differential diagnosis Disorientation Edema Fluorine isotopes Humans Immunoglobulin G Immunoglobulin M Inflammation Ischemia Lesions Lyme disease Lyme Neuroborreliosis - cerebrospinal fluid Lyme Neuroborreliosis - complications Lyme Neuroborreliosis - diagnosis Lymphoma Lymphoma - complications Magnetic resonance imaging Male Meningitis Microglia Middle Aged Middle Cerebral Artery Nervous System Diseases neuroborreliosis Neuroimaging Nimodipine Positron emission Positron emission tomography Vascular diseases Vasculitis Vasculitis - complications Vector-borne diseases |
| title | Lyme neuroborreliosis: An unusual case with extensive (peri)vasculitis of the middle cerebral artery |
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