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Arquivos de Neuro-Psiquiatria

Print version ISSN 0004-282X

Arq. Neuro-Psiquiatr. vol.52 no.4 São Paulo Dec. 1994

http://dx.doi.org/10.1590/S0004-282X1994000400019 

Multiple sclerosis and positive lyme serology

 

Serologia positiva para doença de Lyme e esclerose múltipla

 

 

Marco Aurélio Lana-Peixoto

Professor Adjunto de Neurologia, Faculdade de Medicina da Universidade Federal de Minas Gerais

 

 


SUMMARY

As Lyme neuroborreliosis (LNB) may clinically mimick multiple sclerosis (MS) the presence of antibodies to Borrelia burgdorferi in serum of patients with a MS-like disease in non-edemic areas for Lyme disease may be troublesome. We report the case of a 45-year-old white female with the diagnosis of relapsing/ remitting form of MS due to a 15-year history of optic neuritis and recurrent episodes of motor and sensation disturbance in the upper right limb and in both lower extremites associated with bladder dysfunction. A magnetic resonance imaging of the brain revealed multiple high intensity periventricular white matter lesions. The patient had been exposed to ticks but did not recall the presence of erythema migrans. ELISA for Lyme disease was positive in two different laboratories and the positive serology was confirmed by Western blotting. No convincing reponse followed treatment with ceftriaxone. Although it is clear that the patient had been infect by Borrelia burgdorferi the relationship of this spirochetal infection with the neurological disease could not be ascertained.

Key words: Lyme disease, Lyme neuroborreliosis, multiple sclerosis, positive serology.


RESUMO

As manifestações neurológicas da doença de Lyme são extremamente variadas e podem ocorrer de forma episódica e focal, às vezes simulando o quadro clínico da esclerose múltipla (EM). A situação pode se tornar ainda mais confusa quando pacientes com diagnóstico de EM apresentam anticorpos séricos anti-Borrelia burgdorferi, em áreas não endêmicas para a doença de Lyme. Relatamos o caso de uma paciente de 45 anos de idade com o diagnóstico de EM devido a episódio de neurite óptica há 15 anos e desde então surtos de distúrbios motores e sensitivos no membro superior direito e nos membros inferiores, associados a disfunção esfinctérica. A reação de ELISA para doença de Lyme foi positiva em dois laboratórios diferentes e a positividade foi confirmada por Western blot. Tratamento com ceftriaxone não produziu mudança significativa do quadro clínico. Embora a paciente deva ter sido infectada pela espiroqueta, desenvolvendo então anticorpos séricos específicos, a relação entre esta infecção pela Borrelia burgdorferi e a sintomatologia neurológica, no presente caso, permanece não esclarecida.

Palavras-chave: doença de Lyme, neuroborreliose, esclerose múltipla, serologia positiva.


 

 

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

 

 

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Aceite: 6-maio-1994.

 

 

Dr. Marco Aurélio Lana-Peixoto - Departamento de Neuro-Oftalmologia, Instituto Hilton Rocha - Avenida Anel da Serra 1355 - 30210-090 Belo Horizonte MG - Brasil.

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