1) a Late Stage Lyme disease patient (possibly infected for 9-10 years)
2) only elevated Bb IgM antibody titers
3) no history of EM rash or joint pain
4) treated with high dose penicillin
5) some symptoms improved (chorea - involuntary movements)
6) autopsy 3 years later showed chronic inflammation along with persistent infection in her brain
The Journal of Nuclear Medicine July 1, 1997 vol. 38 no. 7 1120-1122
Brain Perfusion SPECT in Lyme Neuroborreliosis
Hisashi Sumiya, Katsuji Kobayashi, Chikako Mizukoshi, Tatsuyuki Aoki, Yoshifumi Koshino, Junichi Taki
and Norihisa Tonami
Departments of Nuclear Medicine and Psychiatry, Kanazawa University School of Medicine, Kanazawa, Japan
Lyme disease is a multisystemic disease caused by tick-borne spirochete Borrelia burgdorferi, and its invasion into the central nervous system develops a diversity of neurologic and psychiatric disturbances (1,2).
A woman, who had been in good health, became aware of unstable walking at 37 yr. She had not experienced any signs or symptoms of skin lesion or joint pain.
Further laboratory examination of her serum disclosed an elevated titer of antibody against Borrelia burgdorferi by either Western blotting or enzyme-linked immunosorbent assay (11.8pg/dl), IgM titer was elevated. The review of her past history disclosed that the patient had stayed in an area in Minnesota, where Lyme disease is endemic, for 1 yr when she was 28 yr. She was treated with high dose penicillin that was effective for her choreoathetosis and reduction in her serum titer of Borrelia burgdorferi. She died of acute cardiac failure at the age of 40. Autopsy revealed a chronic inflammatory change in the brain and the presence of silver-impregnated organisms, which confirms the neuropathological diagnosis for LNB.