Therapy-resistant depression with fatigue. A case of presumed streptococcal-associated autoimmune disorder

After a tick bite and erythema chronicum migrans, a 31-year-old patient developed headaches, fatigue, multilocular pain and therapy-resistant depression with cognitive disturbances. Antibodies against Borrelia and Borna disease virus, high antibody titers against streptococci at the point of most severe depression and blood-CSF barrier dysfunction were found. Streptococcal antibody titers were normal 2 years before and 4 years after. With penicillin treatment and tonsillectomy, therapy-resistant depression improved. We suggest that the whole syndrome was streptococcal-associated autoimmune disease.