Virginia Research Day 2021

Medical Resident Research Case Reports

14 Chronic Inflammatory Demyelinating Polyradiculopathy From a Case of Neuroborreliosis

Brand, Kenneth MD; Shah, Farhan MD; Choudhury, Asad MD; Junko, Gretchen DO; Curfiss, Ryan, DO; Bingham, JoBeth OMS IV Corresponding author: Kenneth.brand@hcahealthcare.com

Lewis Gale Medical Center-Salem

A 51- year old female with a past medical history of tick bites presented with fever, altered mental status, rash, and worsening lower extremity dysesthesias with ataxia 10 days after beginning outpatient IV Ceftriaxone treatment for Lyme Disease via a Peripherally Inserted Central Catheter. The patient stated she lived by a lake in the woods and has often had to remove ticks from her body. Upon the patient’s arrival to the ED, her temperature was 103° Fahrenheit, and her rash had developed as erythematous, macular, morbilliform, and pruritic; it was distributed from her head down to her waist without evidence of bullae, desquamation, or pus. She was alert and oriented to person, place, time, and location, though had poor insight and answered questions with inappropriate affect. Electromyographic and Nerve Conduction Studies collected the previous week had been negative.

Imaging with MRI had failed to reveal any acute demyelinating processes or radiographic evidence of infection. However, CSF studies revealed specific antibodies to Borrelia, namely: p93 p41, p39, p28, and p18. CSF analysis was suggestive of albuminocytologic dissociation with WBC count of 0/uL, Protein count 294 mg/dL, albumin 225 mg/dL, glucose 68 mg/dL, and RBC’s 0/uL. The PICC tip was removed (cultured negative), Ceftriaxone was switched to oral Doxycycline, and the patient’s fever subsided. She was started on five rounds of IVIG, which resulted in symptomatic amelioration of her lower extremity dysesthesias and gait, diagnosed as CIDP secondary to Neuroborreliosis.

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