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Bannwarth syndrome is synonymous with Lyme neuroborreliosis. The neurological component consists of neuropathy, radicular pain, and lymphocytic pleocytosis. This is due to inflammation of the nerve fibers by Borrelia Burgdorferi. Borrelia Borgdorferi is a spirochete bacteria transmitted hematogenously from the Ixodes tick vector to the human host. The commonly known Lyme disease is diagnosed with symptoms of arthritis, heart block, and integumentary signs. Lyme disease can present as early disseminated or late manifestations of disease. Bannwarth syndrome takes it a step further and emphasizes the neurologic sub set of symptoms. The Centers for Disease Control and Prevention (CDC) estimates about 300,000 new cases annually. It is the triad of neuropathy, radicular pain, and lymphocytic pleocytosis caused by immune inflammation of nerve fibers.
A 73 year old gentleman with a past medical history notable for stage 2 chronic kidney disease and adenocarcinoma of the prostate status post prostatectomy presenting to the emergency department with radicular left sided chest discomfort. It was waxing and waning, unilateral, and radiating to his left upper back for the past one month. For the last 2 weeks leading to this presentation, he had accompanying numbness and tingling in his hands. Upon discussion, he resides in the countryside and spends a great deal of time outdoors during the fall season. His favorite hobbies include collecting tractors and walking his pets.
The 2nd case involves a 24 year old gentleman without significant past medical history presented to the hospital emergency room complaining of progressive upper torso pain and extremity paresthesia for the past month. Developed extremity paresthesias in the forearms along with blurry vision in the right eye. The diagnosis of Disseminated Lyme Infection was made with positive IgM and IgG tests for Lyme Bands. 8 weeks of intravenous ceftriaxone with continued infusion in the outpatient setting was completed. The erythematous migratory rashes disappeared over the following week, and the neuropathies and radicular pain steadily decreased until they disappeared. His EKG reverted back to a normal sinus rhythm without further complications.
A positive IgM is reported when any 2 or more are present: 23, 39, or 41 kDa. This positive antibody test warranted Lyme Western Blot test, which was positive for Borrelia Burgdorferi. He was treated with a 14 day course of doxycycline. After the full course of doxycycline, the chest discomfort resolved. His subsequent clinical course did not show any further complications.
The purpose of this case report is to spotlight the neurologic findings in Bannwarth syndrome. The neurological symptoms that warrant thorough history for Bannwarth Syndrome include radicular pain, neuropathies, and facial/ocular palsy. It is important to differentiate lyme disease from Bannwarth syndrome because the neurologic symptoms dictate duration of treatment. Compared to the common 5 to 7 day course treatment of Lyme’s disease, Bannwarth Syndrome requires at least 3 weeks of treatment. The neurologic physical exam should be included during lyme disease for suspicion of Bannwarth and to broaden the differential. As physicians, we should interrogate these neurologic manifestations and begin early intervention to prevent further complications.
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Arun G, Ali F, Srinivas S, Surath H, Nistico J, Reddy D. Your Next Celebration at US National Parks: A Case Emphasizing Lyme Neuroborreliosis (Bannwarth Syndrome). Advances in Clinical Medical Research and Healthcare Delivery. 2022; 2(1). doi: 10.53785/2769-2779.1061.