The Lyme Disease Network
Conference Abstract

Title:Lyme Disease and the Clinical Spectrum of Antibiotic-Responsive Chronic Meningoencephalomyelitides
Authors:Liegner KB; Duray PM; Agricola M
Conference:9th Annual International Scientific Conference on Lyme Disease & Other Tick-Borne Disorders, Westin Copley Plaza Hotel, Boston, MA, April 19-20, 1996
Presenter:Kenneth B. Liegner, M.D.
Northern Westchester Hospital

1) Initially seronegative, culture +, chronic meningoencephalomyelitides (CMEM), relapsing course; convincing evidence of chronic persistent infection despite intensive therapy.

2) Initially seronegative w. h/o rash c/w ECM, evolving in CMEM w. hydrocephalus and deterioration to a primitive level of neurological function. OspA Ag + and immune complex + in CSF during life and at post-mortem examination. Florid CMEM histologically.

3) Initially seronegative w. h/o tick bite and rash, multi-system symptoms evolving to CMEM. CSF pleocytosis, elevated protein and elevated CSF IgG synthesis rates responding to 8 month course of IV antibiotic therapy. Lyme-specific immune complexes and key bands on Western blot develop on serial CSF examinations during and after treatment 13 year interval between onset of infection and laboratory evidence of LD.

4) CMEM satisfying criteria for M.S. clinically and on CSF parameters. Epidemiological exposure risk for LD but initially seronegative, PCR -, and OspA Ag and Lyme-specific immune-complex negative. Clear neurologic improvement with empiric IV antibiotic treatment with cefotaxime for 5 months. CSF upon repeat examination shows virtually complete resolution of CSF "M.S." markers, development of Lyme-specific immune complexes in serum, and key bands on Western blot, and improvement in MRI of neuraxis. Neurologic deterioration post cessation of treatment. Repeat CSF exam again markedly abnormal. Re-institution of IVAB Rx leads to clear neurologic improvement.

Unique ID: 96LDF020

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