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Ana Margarida Garcia1, José Pedro Vieira2, Maria João Brito1

1- Infectious Diseases Unit, Hospital de Dona Estefânia, CHLC - EPE, Lisbon, Portugal
2- Depatment of Pediatric Neurology, Hospital de Dona Estefânia, CHLC - EPE, Lisbon, Portugal

8th edition of Excellence in Pediatrics, London, 8-10 de Dezembro de 2016 (Poster)

Introduction: The classic triad of neurologic Lyme disease (LD) is lymphocytic meningitis, cranial neuropathy and radiculoneuritis. These neuropathies are commonly related to multifocal axonal process although rare cases of demyelinating neuropathies have been reported in Lyme disease.
Case Report: A four-year-old boy presented with a 10-day history of lower extremity weakness and pain, followed by urinary and fecal incontinence. Five-day before the onset of symptoms was diagnosed a bacterial tonsillitis. At physical examination, global symmetrical weakness, bilateral lower limb areflexia, Gower´s sign and neck stiffness was observed. Lumbar puncture revealed a cerebrospinal fluid (CSF) with albuminocytologic dissociation, with a normal white blood cell count (0,8/uL) and an elevated protein concentration (211,2 mg/dL). Electromyogram was compatible with demyelinating neuropathies, suggesting Guillain-Barré syndrome, so immunoglobulin (Ig) was promptly instituted without significant clinical improvement. The additional investigation revealed positive IgG Western blot to Borrelia burgdorferi in serum and positive IgM ELISA in CSF. VDRL was negative. The microbiologic tests of feces and CSF were negative too, such as immunologic study, including anti-GQ1b. Ceftriaxone was instituted during 14 days, with clinical improvement. At 5-week follow-up the neurologic examination was almost normal, with a slower recovery of the autonomic dysfunction.
Conclusion: This case report highlights an atypical presentation of neuroborreliosis. The presence of CSF Borrelia burgdorferi antibody, which is highly specific for nervous system LD, associated with clinical improvement with antibiotic therapy suggest an infectious rather than an immune-mediated pathogenesis. In patients with GB-like symptoms and demyelinating neuropathies, LD should be considered, in order that adequate treatment can be instituted to maximize recovery. 

Palavras-chave: Lyme disease; neuroborreliosis; Borrelia burgdorferi; Guillain-Barré syndrome