Multiple sclerosis and positive lyme serology

Lana-Peixoto, Marco Aurélio

doi:10.1590/S0004-282X1994000400019

Abstracts

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.

Lyme disease; Lyme neuroborreliosis; multiple sclerosis; positive serology

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.

doença de Lyme; neuroborreliose; esclerose múltipla; serologia positiva

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.

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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.

1. Ackeman R, Rehse-Kupper B, Gollmer E, Schmidt R. Chronic neurologic manifestations of erythema migrans borreliosis. In Benach JL, Bosler EM (eds). Lyme disease and related disorders. New York: New York Acad Sciences, 1988, p 16-23.
2. Afzelius A. Erythema chronicum migrans. Acta Derm Venereol 1921, 2: 120-121.
3. Bernoit P, Dourmon E, Destee A, Warot P. Spirochetes and Lyme disease. Lancet 1986, 2: 1223.
4. Corpuz M, Hilton E, Lardis P, Singer P, Zolan J. Problems in the use of serologic tests for the diagnosis of Lyme disease. Arch Intern Med 1991, 151: 1837-1840.
5. Coyle PK. Borrelia burdorgferi antibodies in multiple sclerosis patients. Neurology 1989, 39: 760-761.
6. Coyle PK, Krupp LB, Doscher C. Significance of reactive Lyme serology in multiple sclerosis. Ann Neurol 1993, 34: 745-747.
7. Craft JE, Grodzicki RL, Steere AC. Antibody response in Lyme disease: evaluation of diagnostic tests. J Infect Dis 1984, 149: 789-795.
8. Finkel MF. Lyme disease and its neurological complications. Arch Neurol 1988,45: 99-104.
9. Fumarola D. Multiple sclerosis and Borrelia burgdorferi. Lancet 1982, 2: 575.
10. Gay D, Dick G. Spirochetes, Lyme disease and multiple sclerosis. Lancet 1986, 2: 685.
11. Halperin J, Luft BJ, Volkman DJ, Dattwiler RJ. Lyme neuroborreliosis: peripheral nervous system manifestations. Brain 1990, 113: 1207-1221.
12. Heller J, Holzer G, Schimrigk K. Immunological differentiation between neuroborreliosis and multiple sclerosis. J Neurol 1990, 237: 465-470.
13. Klöter J, Adams I, Schabet M, Wiethölter H, Pfeiffer J. Borrelia-induced meningoradiculitis: two different forms of the disease. Eur Neurol 1986, 26: 262-268.
14. Kohler J, Kern U, Kasper J, Rhese-Küpper B, Thoden U. Chronic central nervous system involvement in Lyme borreliosis. Neurology 1988, 38: 863-887.
15. Kohler J, Kasper J, Kern J, Thoden U, Rehse-Küpper B. Borrelia encephalomyelitis. Lancet 1988,1: 35.
16. Lana MA, Reis IL. Neurite óptica em doença de Lyme: relato de caso. Arq Neuropsiquiatr 1992, 50 (Supl): 192.
17. Logigian EL, Kaplan RF, Steere AC. Chronic neurologic manifestation of Lyme disease. N Engl J Med 1990, 323: 1438-1444.
18. Luger SW, Krauss E. Serologie tests for Lyme disease: interlaboratory variability. Arch Intern Med 1990, 150: 761-763.
19. Nadelman RB, Pavia CS, Magnarelli LA, Wormser GR Isolation of Borrelia burgdorferi from the blood of seven patients with Lyme disease. Am J Med 1990, 88: 21-26.
20. Pachner AR. Oligoclonal bands in European Lyme disease. Neurology 1985, 35: 1394-1395.
21. Pachner AR. Spirochetal disease of the central nervous system. Neurol Clin 1986,4: 207-222.
22. Pachner AR, Delaney E. The polymerase chain reaction in the diagnosis of Lyme neuroborreliosis. Ann Neurol 1993, 34: 544-550.
23. Pachner AR, Duray P, Steere AC. Central nervous system manifestation of Lyme disease. Arch Neurol 1989, 46: 790-795.
24. Pachner AR, Ricatton NS. Western blotting in evaluating Lyme seropositivity and a utility of a gel densitometric approach. Neurology 1992, 42: 2185-2192.
25. Pachner AR, Steere AC. The triad of neurologic manifestation of Lyme disease: meningitis, cranial neuritis and radiculoneuritis. Neurology 1985, 35: 47-53.
26. Poser CM, Paty DW, Scheinberg L, McDonald WI, Davis FA, Ebers GC, Johnson KP, Sibley WA, Silberberg DH, Tourtellote WW. New diagnostic criteria for multiple sclerosis: guidelines for research protocols. Ann Neurol 1983, 13: 227-231.
27. Reik L, Burgdorfer W, Donaldson JO. Neurologic abnormalities in Lyme disease without erythema migrans. Am J Med 1986, 81:73-78.
28. Rousseau JJ, Lust C, Zangerle PE, Bigaignon G. Acute transverse myelitis as presenting neurological feature of Lyme disease. Lancet 1986, 2: 1222-1223.
29. Schmutzhard E, Pohl P, Stanek G. Borrelia burgdorferi antibodies in patients with relapsing/remitting form and chronic progressive form of multiple sclerosis. J Neurol Neurosurg Psychiatry 1985, 51: 1215-1218.
30. Schmutzhard R, Pohl P, Stanek G. Lyme borreliosis and multiple sclerosis. Lancet 1987, 1: 167-168.
31. Smith JL. Ocular Lyme borreliosis. Intern Ophthalmol Clin 1991, 31: 17-37.
32. Steere AC. Lyme disease. N Engl J Med 1989, 321: 586-596.
33. Steere AC, Malawista SE, Snydman DR, Shope RE, Andiman WA, Ross MP, Steele FM. Lyme arthritis: an epidemic of oligoarthritis in children and adults in three Connecticut communities Arthritis Rheum 1977, 20: 7-17.

Publication Dates

Publication in this collection
19 Jan 2011
Date of issue
Dec 1994

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Ackeman R, Rehse-Kupper B, Gollmer E, Schmidt R. Chronic neurologic manifestations of erythema migrans borreliosis. In Benach JL, Bosler EM (eds). Lyme disease and related disorders. New York: New York Acad Sciences, 1988, p 16-23.

[2] 2. Afzelius A. Erythema chronicum migrans. Acta Derm Venereol 1921, 2: 120-121.

[3] 3. Bernoit P, Dourmon E, Destee A, Warot P. Spirochetes and Lyme disease. Lancet 1986, 2: 1223.

[4] 4. Corpuz M, Hilton E, Lardis P, Singer P, Zolan J. Problems in the use of serologic tests for the diagnosis of Lyme disease. Arch Intern Med 1991, 151: 1837-1840.

[5] 5. Coyle PK. Borrelia burdorgferi antibodies in multiple sclerosis patients. Neurology 1989, 39: 760-761.

[6] 6. Coyle PK, Krupp LB, Doscher C. Significance of reactive Lyme serology in multiple sclerosis. Ann Neurol 1993, 34: 745-747.

[7] 7. Craft JE, Grodzicki RL, Steere AC. Antibody response in Lyme disease: evaluation of diagnostic tests. J Infect Dis 1984, 149: 789-795.

[8] 8. Finkel MF. Lyme disease and its neurological complications. Arch Neurol 1988,45: 99-104.

[9] 9. Fumarola D. Multiple sclerosis and Borrelia burgdorferi. Lancet 1982, 2: 575.

[10] 10. Gay D, Dick G. Spirochetes, Lyme disease and multiple sclerosis. Lancet 1986, 2: 685.

[11] 11. Halperin J, Luft BJ, Volkman DJ, Dattwiler RJ. Lyme neuroborreliosis: peripheral nervous system manifestations. Brain 1990, 113: 1207-1221.

[12] 12. Heller J, Holzer G, Schimrigk K. Immunological differentiation between neuroborreliosis and multiple sclerosis. J Neurol 1990, 237: 465-470.

[13] 13. Klöter J, Adams I, Schabet M, Wiethölter H, Pfeiffer J. Borrelia-induced meningoradiculitis: two different forms of the disease. Eur Neurol 1986, 26: 262-268.

[14] 14. Kohler J, Kern U, Kasper J, Rhese-Küpper B, Thoden U. Chronic central nervous system involvement in Lyme borreliosis. Neurology 1988, 38: 863-887.

[15] 15. Kohler J, Kasper J, Kern J, Thoden U, Rehse-Küpper B. Borrelia encephalomyelitis. Lancet 1988,1: 35.

[16] 16. Lana MA, Reis IL. Neurite óptica em doença de Lyme: relato de caso. Arq Neuropsiquiatr 1992, 50 (Supl): 192.

[17] 17. Logigian EL, Kaplan RF, Steere AC. Chronic neurologic manifestation of Lyme disease. N Engl J Med 1990, 323: 1438-1444.

[18] 18. Luger SW, Krauss E. Serologie tests for Lyme disease: interlaboratory variability. Arch Intern Med 1990, 150: 761-763.

[19] 19. Nadelman RB, Pavia CS, Magnarelli LA, Wormser GR Isolation of Borrelia burgdorferi from the blood of seven patients with Lyme disease. Am J Med 1990, 88: 21-26.

[20] 20. Pachner AR. Oligoclonal bands in European Lyme disease. Neurology 1985, 35: 1394-1395.

[21] 21. Pachner AR. Spirochetal disease of the central nervous system. Neurol Clin 1986,4: 207-222.

[22] 22. Pachner AR, Delaney E. The polymerase chain reaction in the diagnosis of Lyme neuroborreliosis. Ann Neurol 1993, 34: 544-550.

[23] 23. Pachner AR, Duray P, Steere AC. Central nervous system manifestation of Lyme disease. Arch Neurol 1989, 46: 790-795.

[24] 24. Pachner AR, Ricatton NS. Western blotting in evaluating Lyme seropositivity and a utility of a gel densitometric approach. Neurology 1992, 42: 2185-2192.

[25] 25. Pachner AR, Steere AC. The triad of neurologic manifestation of Lyme disease: meningitis, cranial neuritis and radiculoneuritis. Neurology 1985, 35: 47-53.

[26] 26. Poser CM, Paty DW, Scheinberg L, McDonald WI, Davis FA, Ebers GC, Johnson KP, Sibley WA, Silberberg DH, Tourtellote WW. New diagnostic criteria for multiple sclerosis: guidelines for research protocols. Ann Neurol 1983, 13: 227-231.

[27] 27. Reik L, Burgdorfer W, Donaldson JO. Neurologic abnormalities in Lyme disease without erythema migrans. Am J Med 1986, 81:73-78.

[28] 28. Rousseau JJ, Lust C, Zangerle PE, Bigaignon G. Acute transverse myelitis as presenting neurological feature of Lyme disease. Lancet 1986, 2: 1222-1223.

[29] 29. Schmutzhard E, Pohl P, Stanek G. Borrelia burgdorferi antibodies in patients with relapsing/remitting form and chronic progressive form of multiple sclerosis. J Neurol Neurosurg Psychiatry 1985, 51: 1215-1218.

[30] 30. Schmutzhard R, Pohl P, Stanek G. Lyme borreliosis and multiple sclerosis. Lancet 1987, 1: 167-168.

[31] 31. Smith JL. Ocular Lyme borreliosis. Intern Ophthalmol Clin 1991, 31: 17-37.

[32] 32. Steere AC. Lyme disease. N Engl J Med 1989, 321: 586-596.

[33] 33. Steere AC, Malawista SE, Snydman DR, Shope RE, Andiman WA, Ross MP, Steele FM. Lyme arthritis: an epidemic of oligoarthritis in children and adults in three Connecticut communities Arthritis Rheum 1977, 20: 7-17.