Lyme neuroborreliosis presenting chiefly with neuropsychiatric symptoms displaying difficulties in diagnosis: Report of two cases

Abstract

Lyme disease is an infectious disease caused by the tick-borne spirochete Borrelia burgdorferi. Its clinical hallmark, erythema migrans, is present only in about two thirds of infected patients. After erythema migrans, Bannwarth's syndrome (meningitis, polyradiculoneuritis, cranial nerve palsies) represents the second most common clinical manifestation of acute Borrelia infection, especially in Europe. We describe here two cases of Lyme neuroborreliosis presenting chiefly with neuropsychiatric symptoms displaying difficulties in diagnosis because the patients had no history of tick bite or erythema migrans. In one of the cases, psychiatric complaints were predominant and she had a preliminary diagnosis of catatonic and psychotic disorder due to a general medical condition. The other patient had a clinical picture of meningitis with a protracted course. They were successfully treated with oral doxycycline. Apropos of these two cases, the relevant literature has been reviewed.

Keywords

Lyme disease - neuroborreliosis - neuropsychiatric symptoms - meningitis - treatment