Page 1 of 1

Seronegative Lyme arthritis (2007)

Posted: Wed 31 Oct 2007 2:37
by Martian
Rheumatol Int. 2007 Apr 4

Seronegative Lyme arthritis.

* Holl-Wieden A,
* Suerbaum S,
* Girschick HJ.

Children's hospital, Section of Pediatric Rheumatology, Immunology and Infectious diseases, University of Wuerzburg, Josef-Schneider-Str. 2, 97090, Wuerzburg, Germany, Hermann.Girschick@mail.uni-wuerzburg.de.

We present a 10-year-old girl who had been diagnosed with juvenile idiopathic arthritis 5 years before and who experienced a flare of arthritis affecting one knee while she was off medication for almost 3 years. Seronegative Lyme arthritis had to be diagnosed based on the detection of Borrelia burgdorferi DNA in synovial fluid. No humoral immune response to Borrelia burgdorferi was detectable before, at the time of diagnosis and up to 3 years later.

PMID: 17406870 [PubMed - as supplied by publisher]

Re: Seronegative Lyme arthritis (2007)

Posted: Thu 1 Nov 2007 20:57
by Nick
and who knows how many other 'arthritis' (or fibromyalgia etc.) patients will have borrelia if you start looking for it ...

Seronegative Lyme & Leukemia

Posted: Thu 26 Mar 2009 19:35
by Joe Ham
Infection. 2007 Apr;35(2):110-3.
Seronegative Lyme neuroborreliosis in a patient on treatment for chronic lymphatic leukemia.
http://www.ncbi.nlm.nih.gov/pubmed/17401717

Harrer T, Geissdörfer W, Schoerner C, Lang E, Helm G.
Dept. of Medicine III, University Hospital Erlangen, Krankenhausstr. 12, 91054, Erlangen, Germany. Thomas.Harrer@med3.imed.uni-erlangen.de

We report on a patient who developed seronegative Lyme neuroborreliosis complicating chemotherapy for chronic lymphatic leukemia.

After the fifth cycle of chemotherapy (FCR: fludarabine, cyclophosphamide, rituximab and prednisone) the 63-year-old patient developed night sweat, arthralgia in elbows, wrists, proximal interphalangeal joints (PIPs) and strong neuropathic pain in both legs, followed by paresthesia and hypesthesia in the feet, arms and face. Laboratory analysis revealed an elevated C-reactive protein (CRP), a slight elevation of liver enzymes and decreased IgG levels. Cerebrospinal fluid (CSF) analysis showed a lymphomononuclear pleocytosis and an elevation of protein.

A broad diagnostic work-up was negative including a negative Borrelia IgG and IgM ELISA. The patient did not remember recent tick bites, but after specific questioning he recollected a transient erythema on his leg developing just before the start of the last cycle of chemotherapy. As the combination of neuropathic pain and arthralgia, the transient erythema and the lymphomononuclear pleocytosis raised the suspicion of Lyme neuroborreliosis, the patient was treated for 3 weeks with ceftriaxone.

On therapy all symptoms resolved and CRP normalized. Retrospective PCR analysis of a CSF sample confirmed the clinical diagnosis by detecting Borrelia garinii DNA.

This case demonstrates that in immunosuppressed patients borrelial serology may be negative and that additional diagnostic approaches (including tests for direct Borrelia detection) may be needed to demonstrate borrelial infection.

PMID: 17401717 [PubMed - indexed for MEDLINE]
One has to wonder how many leukemia or lymphoma patients have their death hastened by immune suppressing anti-neoplastic drugs -- never having received an accurate diagnosis.

Such seems by hindsight to be the case with Jack Gardetto.
He had received a diagnosis of leukemia somewhere in the middle of his battle with Lyme. However, when the test for leukemia was negative the diagnosis was change to lymphoma but no biopsy or other test was done. He was treated with cancer drugs but I said nothing because I didn't know at the time that they are so strongly immune suppressing.

He was failed by both allopathic and homeopathic medicine. He didn't have a chance.

Re: Seronegative Lyme arthritis (2007)

Posted: Thu 26 Mar 2009 20:05
by Fin24
the erythema rash was AFTER several cycles of chemo so the presumptive differential is that he HAD cancer first , started chemo then was infected by Lyme

that and the fact that symptoms didnt start until several chemo cycles leads ME to think the cancer and cancer tx was PREVIOUS to the Lyme infection--it is reasonable to think that by the 2nd or 3rd cycle, Lyme sx would have been very bad due to the immune suppression you mentioned!! and yet---not so MY guess is it was contracted later

unless you can show otherwise this isnt a case of a current non diagnosed or misdiagnosed Borrelia infection being hastened or exacerbated by the onset of chemo drug therapy--rather its a case of having the unfortunate "bad luck" of contracting Lyme DURING chemo tx and being more vulnerable ( which is one of the very explained risks of even doing chemo)

its unusual to be sure and sad as well but its the same as contracting a deadly influenza while undergoing chemo-
a sad,unlucky coincidence


the case also points out that pts already immunosuppressed cant rely upon seropositivity for diagnoses----and to be aware that your pt may contract diseases that confound the tx despite neg tests. which to ME is a no brainer

look at Evan--his hereditary CVIDS means less immune cells that will respond to or react to pathogens and so he is less likely to be seropositive