Case report: Persistently seronegative neuroborreliosis in an immunocompromised patient
| العنوان: | Case report: Persistently seronegative neuroborreliosis in an immunocompromised patient |
|---|---|
| المؤلفون: | N. W. C. J. van de Donk, Laura A. N. Peferoen, B. de Wever, Alex Wagemakers, E. J. Hendriks, F. F. Muller, C. W. Ang, Joppe W. Hovius, Marieke C. Visser |
| المساهمون: | AII - Infectious diseases, Center of Experimental and Molecular Medicine, Infectious diseases, Medical Microbiology and Infection Prevention, VU University medical center, Hematology, Radiology and nuclear medicine, Pathology, Amsterdam Neuroscience - Neuroinfection & -inflammation, Neurology, AGEM - Digestive immunity |
| المصدر: | BMC infectious diseases, 18(1):362. BioMed Central BMC Infectious Diseases, Vol 18, Iss 1, Pp 1-5 (2018) BMC Infectious Diseases, 18(1):362. BioMed Central Wagemakers, A, Visser, M C, de Wever, B, Hovius, J W, van de Donk, N W C J, Hendriks, E J, Peferoen, L, Muller, F F & Ang, C W 2018, ' Case report: Persistently seronegative neuroborreliosis in an immunocompromised patient ', BMC Infectious Diseases, vol. 18, no. 1, 362 . https://doi.org/10.1186/s12879-018-3273-8 BMC Infectious Diseases |
| سنة النشر: | 2018 |
| مصطلحات موضوعية: | Male, 0301 basic medicine, 030106 microbiology, Case Report, Lymphoma, Mantle-Cell, Serology, lcsh:Infectious and parasitic diseases, Immunocompromised Host, 03 medical and health sciences, 0302 clinical medicine, Borrelia, Diagnosis, Humans, Lyme Neuroborreliosis, Medicine, Disseminated disease, lcsh:RC109-216, 030212 general & internal medicine, Borrelia burgdorferi, Immunocompromised, biology, business.industry, Neuroborreliosis, medicine.disease, biology.organism_classification, bacterial infections and mycoses, Infectious Diseases, Immunology, Rituximab, Differential diagnosis, business, medicine.drug |
| الوصف: | Background Infection with Borrelia burgdorferi sensu lato complex (B. b. sl) spirochetes can cause Lyme borreliosis, manifesting as localized infection (e.g. erythema migrans) or disseminated disease (e.g. Lyme neuroborreliosis). Generally, patients with disseminated Lyme borreliosis will produce an antibody response several weeks post-infection. So far, no case of neuroborreliosis has been described with persistently negative serology one month after infection. Case presentation We present a patient with a history of Mantle cell lymphoma and treatment with R-CHOP (rituximab, doxorubicine, vincristine, cyclofosfamide, prednisone), with a meningo-encephalitis, who was treated for a suspected lymphoma relapse. However, no malignant cells or other signs of malignancy were found, and microbial tests did not reveal any clues, including Borrelia serology. He did not recall being bitten by ticks, and a Borrelia PCR on CSF was negative. After spontaneous improvement of symptoms, he was discharged without definite diagnosis. Several weeks later, he was readmitted with a relapse of symptoms of meningo-encephalitis. This time however, a Borrelia PCR on CSF was positive, confirmed by two independent laboratories, and the patient received ceftriaxone upon which he partially recovered. Interestingly, during the diagnostic process of this exceptionally difficult case, a variety of different serological assays for Borrelia antibodies remained negative. Only P41 (flagellin) IgG was detected by blot and the Liaison IgG became equivocal 2 months after initial testing. Conclusions To the best of our knowledge this is the first case of neuroborreliosis that is seronegative on repeated sera and multiple test modalities. This unique case demonstrates the difficulty to diagnose neuroborreliosis in severely immunocompromised patients. In this case, a delay in diagnosis was caused by broad differential diagnosis, an absent known history of tick bites, negative serology and the low sensitivity of PCR on CSF. Therefore, awareness of the diagnostic limitations to detect Borrelia infection in this specific patient category is warranted. Electronic supplementary material The online version of this article (10.1186/s12879-018-3273-8) contains supplementary material, which is available to authorized users. |
| اللغة: | English |
| تدمد: | 1471-2334 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::a6d1ac1b94d6fc431d925a87c316db1e https://pure.amc.nl/en/publications/case-report-persistently-seronegative-neuroborreliosis-in-an-immunocompromised-patient(7de16025-58e4-4794-a986-bb70e6ac1a8b).html |
| حقوق: | OPEN |
| رقم الأكسشن: | edsair.doi.dedup.....a6d1ac1b94d6fc431d925a87c316db1e |
| قاعدة البيانات: | OpenAIRE |
Find this article in full text from Springer Verlag. | تدمد: | 14712334 |
|---|