Ewers Evan C, Dennison David H, Stagliano David R
Department of Medicine, Tripler Army Medical Center, Honolulu, Hawaii.
Department of Neurology, Walter Reed National Military Medical Center, Bethesda, Maryland.
Pediatr Neurol. 2015 Jan;52(1):107-9. doi: 10.1016/j.pediatrneurol.2014.10.009. Epub 2014 Oct 16.
Lyme disease is the most common vector-borne disease in the United States and is caused by infection with the spirochete Borrelia burgdorferi. In children, neuroborreliosis usually presents as peripheral facial nerve palsy and lymphocytic meningitis and only rarely is associated with cranial polyneuritis.
We present a 15-year-old with tinnitus, hearing loss, and facial nerve palsy in the setting of acute, severe right arm pain and a several week history of malaise and headache. Lumbar puncture was notable for lymphocytic pleocytosis. Serologic testing demonstrated positive Lyme antibody and a positive immunoglobulin M Western blot. Immunofluorescent assay of cerebrospinal fluid was also positive for anti-Lyme immunoglobulin M. Audiologic testing revealed mixed, right-sided hearing loss. Neuroimaging demonstrated cranial polyneuritis and right-sided cochlear inflammation. The patient was treated with parenteral ceftriaxone with resolution of his symptoms at close follow-up.
Neuroborreliosis with radiculopathy, lymphocytic meningitis, and cranial polyneuritis is a rare presentation of pediatric Lyme disease. Additionally, cochlear inflammation along with cranial nerve VIII inflammation may contribute to hearing loss in patients with neuroborreliosis.
莱姆病是美国最常见的媒介传播疾病，由螺旋体伯氏疏螺旋体感染引起。在儿童中，神经型伯氏疏螺旋体病通常表现为周围性面神经麻痹和淋巴细胞性脑膜炎，很少与颅神经炎相关。
我们报告一名15岁患者，在急性严重右臂疼痛以及数周的不适和头痛病史背景下，出现耳鸣、听力丧失和面神经麻痹。腰椎穿刺显示淋巴细胞增多。血清学检测显示莱姆抗体阳性和免疫球蛋白M免疫印迹阳性。脑脊液免疫荧光检测抗莱姆免疫球蛋白M也呈阳性。听力测试显示右侧混合性听力损失。神经影像学显示颅神经炎和右侧耳蜗炎症。患者接受了静脉注射头孢曲松治疗，密切随访时症状缓解。
伴有神经根病、淋巴细胞性脑膜炎和颅神经炎的神经型伯氏疏螺旋体病是小儿莱姆病的罕见表现。此外，耳蜗炎症以及第八颅神经炎症可能导致神经型伯氏疏螺旋体病患者听力丧失。
