P 336. Unusual Manifestation of Lyme Neuroborreliosis in Childhood and Adolescence

Background: Acute Lyme neuroborreliosis in children and adolescents usually manifests as peripheral facial paralysis, aseptic meningitis, or meningoradiculoneuritis.

Case report: A 13-year-old patient, for 4 weeks increasing hypesthesia of the fingers of the right hand with reduction of strength, tickling in the right thigh. The patient had no fever, no B symptoms, and no trauma. There was a history of tick bite.

Family history: ALS (grandfather)

Diagnostics: Physical examination: Decreased sensitivity of the upper 2/3 of the fingers of the right hand, reduced strength of the right hand 4/5.

Cerebrospinal Fluid (CSF) diagnostics: Status: leukocytes 153/µL, erythrocytes 0, mononuclear cells 99%, polymorph nuclear cells 1%, glucose 47 mg/dL (reduced), CSF protein 101 mg/dL (increased), and lactate 1.89 mmol/L.

Oligoclonal bands in CSF positive, in serum negative

Immunological diagnostics: Aquaporin-4-AK: negative, MOG-AK: negative

Borrelia in serum: Borrelia IgG > 240.0 AU/ml (<10), Borrelia IgM 0.3 ratio (<0.9); Borrelia in CSF: IgM AI 10 (<1.5), Borrelia IgG AI 18.4 (<1.5); Borrelia immunoblot not performed.

Imaging:

cMRI: Normal

MRI spinal canal: Eextensive myelitis transversa in the cervical spine ranging from C3 to C6.

Conclusion: The cause of our patient’s symptoms and MRI changes was neuroborreliosis which is a rare but treatable cause of LETM in childhood and adolescence. After antibiotic therapy (ceftriaxone), our patient recovered, with normal strength and only occasional tickling in her right hand and right thigh. LETM in children is usually associated with AQP4 or more often with MOG antibodies but not with MS.