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SAT0223 Lyme meningoradiculitis in an endemic zone: clinical signs
  1. F Roux1,
  2. L Artru2,
  3. B Haettich2,
  4. J Esparbes2,
  5. X Puéchal2
  1. 1Rheumatology, Hospital Bichat, Paris
  2. 2Rheumatology, Le Mans General Hospital, Le Mans, France

Abstract

Background Neuroborreliosis has been called “the new great imitator”.

Objectives The aim of this study was to define the symptoms of meningoradiculitis.

Methods We collected prospective data from all patients admitted to hospital with Lyme meningoradiculitis between June 1st, 1998 and December 31st, 1999 in an endemic zone located in western France. Diagnosis was based on lymphocytic meningitis associated with either intrathecal specific antibody synthesis or high serum titers of specific IgM in ELISA and western Blot analysis.

Results Eleven patients (9 women, 2 men), with a mean age of 62 years (range: 37 to 87) were included during the study period. Two thirds of these patients were admitted to rheumatology wards during the summer. The onset of symptoms was preceded, 5 to 60 days earlier, by a tick bite in 64% of cases or erythema migrans in 55% of cases. In 18% of patients, neither a tick bite nor erythema was observed. Non specific symptoms were recorded in 82% of cases, with transient fever or flu syndrome in 45% of all cases. Cervical radiculoneuritis was observed in 4 cases, symptoms affecting several nerve roots of the lower limbs in 3 cases, femoral neuropathy in 2 cases, a bilateral sensory radiculoneuritis T11–12 in one case and poorly localised paresthesias in the lower limbs in one case. The meningeal signs and symptoms were minimal or, more frequently, absent. A peripheral motor paresis was observed in one quarter of the cases, but without Bell’s palsy or encephalic or medullary signs. In half the patients, there was associated spinal pain not relieved by rest. All patients reported nocturnal exacerbation in pain. The electrocardiographic abnormalities included first-degree atrioventricular block in 2 patients. The course of the disease was consistently favourable on ceftriaxone IV treatment, with rapid effective relief of pain.

Conclusion A diagnosis of Lyme meningoradiculitis should be considered in endemic zones in all cases of spine pain and/or radiculitis with nocturnal exacerbation, especially in the summer period.

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