Miyazaki K, Iijima M, Takeuchi M, Uchiyama S, Iwata M
Department of Neurology, Tokyo Women's Medical College.
Rinsho Shinkeigaku. 1996 Oct;36(10):1155-60.
A 24-year-old male patient was admitted to our hospital because of dysesthesia and weakness of the right leg. Six weeks before admission he traveled to southern China. A week later he noticed multiple papules with itching on his right leg that were suspected to be insect bites. Four days later numbness of the right leg developed. Then he began to limp because of the leg weakness. Two weeks before admission severe pain in the right leg developed. On admission neurological examination revealed hypesthesia, muscle weakness and atrophy, areflexia, radicular pain and Lasègue sign of the right leg, and patchy hypesthesia of the left leg. The cranial nerves were intact, and meningeal signs were negative. Complete blood counts and serum biochemistry were unremarkable except for eosinophilia and mild elevation of IgE. A test for antinuclear antibody was positive. Cerebrospinal fluid was normal. Nerve conduction study and sural nerve biopsy showed multifocal severe axonopathy. Although antibody for Borrelia burgdorferi sensu stricto was negative, antibodies for B. garinii and for B. afzelii were positive in serum immunoblotting. Neurological symptoms improved after administration of intravenous ceftriaxon following oral doxycycline. In Japan, this is the second case of neuroborreliosis not due to B. burgdorferi sensu stricto. To test antibodies for B.garinii and for B. afzelii is recommended in patients with suspected neuroborreliosis.
一名24岁男性患者因右腿感觉异常和无力入院。入院前六周他前往中国南方。一周后，他注意到右腿出现多个伴有瘙痒的丘疹，怀疑是昆虫叮咬。四天后，右腿出现麻木。然后他开始因腿部无力而跛行。入院前两周，右腿出现剧痛。入院时神经学检查发现右腿感觉减退、肌肉无力和萎缩、反射消失、神经根性疼痛和拉塞格征，左腿有片状感觉减退。颅神经完好，脑膜刺激征阴性。全血细胞计数和血清生化检查除嗜酸性粒细胞增多和IgE轻度升高外无异常。抗核抗体检测呈阳性。脑脊液正常。神经传导研究和腓肠神经活检显示多灶性严重轴索性神经病。尽管严格意义上的伯氏疏螺旋体抗体阴性，但在血清免疫印迹中，伽氏疏螺旋体和阿氏疏螺旋体抗体呈阳性。口服强力霉素后静脉注射头孢曲松，神经症状改善。在日本，这是第二例非由严格意义上的伯氏疏螺旋体引起的神经莱姆病。对于疑似神经莱姆病的患者，建议检测伽氏疏螺旋体和阿氏疏螺旋体抗体。
