Cassarino David S, Quezado Martha M, Ghatak Nitya R, Duray Paul H
Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Md 20892, USA.
Arch Pathol Lab Med. 2003 Sep;127(9):1204-6. doi: 10.5858/2003-127-1204-LPANCS.
Neurological complications of Lyme disease include meningitis, encephalitis, dementia, and, rarely, parkinsonism. We present a case of striatonigral degeneration, a form of multiple system atrophy, in Lyme-associated parkinsonism. A 63-year-old man presented with erythema migrans rash, joint pains, and tremors. Serum and cerebrospinal fluid antibodies and polymerase chain reaction for Borrelia burgdorferi were positive. Clinical parkinsonism was diagnosed by several neurologists. Despite treatment, the patient continued to decline, with progressive disability, cognitive dysfunction, rigidity, and pulmonary failure. At autopsy, the brain showed mild basal ganglia atrophy and substantia nigra depigmentation, with extensive striatal and substantia nigral neuronal loss and astrogliosis. No Lewy bodies were identified; however, ubiquitin-positive glial cytoplasmic inclusions were identified in striatal and nigral oligodendroglia. There were no perivascular or meningeal infiltrates, the classic findings of neuroborreliosis. To our knowledge, this is the first report of striatonigral degeneration in a patient with B burgdorferi infection of the central nervous system and clinical Lyme-associated parkinsonism.
莱姆病的神经并发症包括脑膜炎、脑炎、痴呆，以及罕见的帕金森综合征。我们报告一例莱姆病相关性帕金森综合征患者出现纹状体黑质变性，这是多系统萎缩的一种形式。一名63岁男性出现游走性红斑皮疹、关节疼痛和震颤。血清和脑脊液中针对伯氏疏螺旋体的抗体及聚合酶链反应均呈阳性。几位神经科医生诊断为临床帕金森综合征。尽管进行了治疗，患者仍持续恶化，出现进行性残疾、认知功能障碍、强直和呼吸衰竭。尸检时，大脑显示基底节轻度萎缩和黑质色素脱失，伴有广泛的纹状体和黑质神经元丢失及星形胶质细胞增生。未发现路易小体；然而，在纹状体和黑质少突胶质细胞中发现了泛素阳性的胶质细胞胞质内包涵体。没有血管周围或脑膜浸润，而这是神经莱姆病的典型表现。据我们所知，这是首例关于中枢神经系统感染伯氏疏螺旋体且伴有临床莱姆病相关性帕金森综合征患者出现纹状体黑质变性的报告。
