Guillain-Barré syndrome in a course of early cutaneous type of Lyme borreliosis: diagnostic and therapeutic difficulties
Wiszniewska, M.łg.; Szmaglińska, H.; Kozubski, W.
Neurologia i Neurochirurgia Polska 39(5): 412-416
2005
ISSN/ISBN: 0028-3843 PMID: 16273467 Document Number: 591476
A case is reported of a 33-year-old man in whom Guillain-Barré syndrome (GBs) developed three weeks after a tick's sting. At the sting site typical for an early cutaneous type of Lyme borreliosis -- erythema migrans -- appeared. The demyelinating polyradiculoneuropathy of GBs occurred after disappearance of erythema migrans, and was manifested by progressive neuropathic symmetrical limb weakness with distal numbness and pain, and bilateral facial paralysis. The GBs was confirmed by electrophysiological examination and elevated protein concentration with a normal range of cells in the cerebrospinal fluid. Antibodies IgM and IgG against Borrelia burgdorferi in the blood serum and cerebrospinal fluid assessed using immunoenzymatic assay, MEIA, were negative on account of their early search. The above findings suggested that the GBs appearance after the probable Borrelia burgdorferi infection was in fact due to that infection. The patient recovered after treatment with plasma-phoresis and corticosteroid therapy followed by intravenous immunoglobulin, and physiotherapy. This is the first case in the Polish neurological literature of GBs with an early skin form of borreliosis which developed after the tick's sting.