Orthopaedics, NHS Forth Valley, Larbert, UK.
Microbiology, NHS Forth Valley, Larbert, UK
BMJ Case Rep. 2023 Jun 2;16(6):e251982. doi: 10.1136/bcr-2022-251982.
A man in his 70s presented to hospital in early summer with a 5-week history of progressive lower back and right thigh pain, sensory deficit and right leg weakness. There had been limited response to analgesics in the community. Primary investigations on admission revealed no cause for his symptoms. Five days into admission, history emerged of a possible tick bite with subsequent rash sustained 3 months earlier, raising the possibility of neuroborreliosis leading to radiculopathy. Cerebrospinal fluid demonstrated a lymphocytic pleocytosis. An elevated antibody index confirmed a diagnosis of Lyme neuroborreliosis. The patient was treated successfully with 28 days of intravenous ceftriaxone, analgesia and physiotherapy. Within the literature, Lyme radiculopathy is a common presentation of neuroborreliosis and should be considered and investigated in patients without radiological evidence of a mechanical cause of worsening lower back pain in settings with endemic Lyme disease.
一位 70 多岁的男性初夏时因持续 5 周的下背部和右大腿疼痛、感觉缺失和右腿无力到医院就诊。在社区治疗中镇痛药的效果有限。入院时的初步检查未发现导致其症状的原因。住院 5 天后，出现了可能被蜱虫叮咬的病史，随后在 3 个月前出现皮疹，这增加了神经莱姆病导致神经根病的可能性。脑脊液显示淋巴细胞增多。升高的抗体指数证实了莱姆神经Borreliosis 的诊断。该患者接受了 28 天的静脉头孢曲松、镇痛和物理治疗，治疗成功。在文献中，莱姆神经根病是神经莱姆病的常见表现，在莱姆病流行地区，如果没有影像学证据表明下背部疼痛恶化是机械性原因引起的，应考虑并对这些患者进行检查。
