Szyfelbein W M, Ross J S
Department of Pathology, Harvard Medical School, Boston, Massachusetts.
Mod Pathol. 1988 Nov;1(6):464-8.
Lyme disease is a multisystem disorder resulting from infection by the tick-borne spirochete, Borrelia burgdorferi. Fever, chills, malaise and headaches; a characteristic rash; and subsequent polyarthritis typically herald the onset of this condition. Neurologic involvement may occur with skin and joint manifestations or present alone as meningitis, cranial neuritis, and radiculopathy known as Bannwarth's syndrome. We report the cerebrospinal fluid (CSF) cytomorphologic and immunocytochemical features of four patients who presented with isolated meningitis, cranial neuritis, and painful neuropathy without initial history of specific skin rash or previous tick bite. Initial CSF findings of significant numbers of markedly atypical plasmacytoid mononuclear cells suggested CSF non-Hodgkin's malignant lymphoma. Immunocytochemical studies on CSF specimens, however, revealed polyclonal surface immunoglobulin patterns consistent with an inflammatory reaction. Follow-up clinical history and/or peripheral blood serologic testing for antibody titers with B. burgdorferi antigen confirmed the diagnosis of Lyme disease in all four cases. We conclude that Lyme disease may present as atypical spinal fluid lymphoplasmacytic cellular infiltrates that simulate malignant lymphoma and that appropriate immunocytochemical studies and peripheral blood serologic testing be performed to establish this diagnosis and direct appropriate therapy.
莱姆病是一种多系统疾病，由蜱传播的螺旋体伯氏疏螺旋体感染引起。发热、寒战、不适和头痛；特征性皮疹；以及随后的多关节炎通常预示着该病的发作。神经系统受累可能与皮肤和关节表现同时出现，或单独表现为脑膜炎、颅神经炎和神经根病，即班沃特综合征。我们报告了4例患者的脑脊液（CSF）细胞形态学和免疫细胞化学特征，这些患者表现为孤立性脑膜炎、颅神经炎和疼痛性神经病变，最初没有特定皮疹或既往蜱叮咬史。最初脑脊液检查发现大量明显非典型的浆细胞样单核细胞，提示脑脊液非霍奇金恶性淋巴瘤。然而，对脑脊液标本的免疫细胞化学研究显示，多克隆表面免疫球蛋白模式与炎症反应一致。随访临床病史和/或用伯氏疏螺旋体抗原检测外周血抗体滴度，证实所有4例均为莱姆病。我们得出结论，莱姆病可能表现为非典型的脊髓液淋巴浆细胞浸润，类似恶性淋巴瘤，应进行适当的免疫细胞化学研究和外周血血清学检测以确立诊断并指导适当治疗。
