1 - Unidade de Infecciologia, Pediatria, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa.
2 - Unidade de Cuidados Intensivos Pediátricos, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa.
3 - Unidade de Neurologia, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa.
4 - Unidade de Neurorradiologia, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa.
5 - Unidade de Infecciologia, Pediatria, Hospital Dona Estefânia, Centro Hospitalar Universitário Lisboa Central, Lisboa.
- Reunião internacional (ESPID 2020)
Resumo:
Background: Lyme borreliosis is a multisystemic disease with a wide range of clinical manifestations. Neurologic involvement occurs in 5-10% of patients, affecting either the peripheral or central nervous system. Lyme transverse myelitis is a severe and uncommon presentation in children.
Case Report: A previously healthy 16-year-old girl was admitted with fever and bilateral lower limb pain with paraesthesia, abdominal pain and vomiting. Three days after, she evolved with symmetrical paraparesia, diminished facial mimicry, hypoesthesia of D10-12 dermatomes, decreased proprioception of the lower extremities and a urinary retention episode. Brain and spinal cord (SC) magnetic resonance imaging revealed multiple T2 hyperintense lesions on the brain but also an extended involvement of the SC affecting the grey matter in all its length and the white matter from C5-C7. This was suggestive of encephalomyelitis with a severe transverse myelitis. The cerebrospinal fluid (CSF) revealed pleocytosis (160cells/mm3, lymphocytes) normal protein level (57,9mg/dL) and normal glycorrhachia (54mg/dL). The serum Borrelia burgdorferi s.I (BB) specific antibodies were inconclusive by ELISA (serion) but positive by immunoblot (anti-Borrelia Euroline RN-AT, Euroimmun) with serum-specific bands on IgM (OspC Bg, OspC Bb and OspCBa) and IgG (VlsE Ba, VlsE Bb, VlsE Bg and p41). Intrathecal index confirmed blood-brain barrier disruption (=33.04 g/L, >2). The patient was treated with intravenous ceftriaxone for 3 weeks, immunoglobulin for two days and methylprednisolone for 5 days, with clinical recovery within the first month.
Conclusions: Borreliosis diagnosis is often difficult in low prevalence areas, such as Portugal. The presence of serum-specific bands on IgM and IgG by immunoblot suggest the diagnosis. In children, although Lyme encephalomyelitis is rare, it must be considered on differential diagnosis of transverse myelitis.
Palavras Chave: borreliosis, encephalomyelitis, transverse myelitis