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2013 | 8 | 4 | 463-467
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Borreliosis presenting as autonomic nervous dysfunction, phrenic nerve palsy with respiratory failure and myocardial dysfunction - a case report

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Unrecognized and untreated Borrelia infection can progress from localized inflammation (erythema migrans) to early or late generalized stage within weeks to months. Meningoradiculitis, arthritis, multiple erythemas, myositis, and myocarditis of the early generalized stage have a good prognosis after antibiotic treatment, but late manifestations can progress to chronic disease. Phrenic nerve palsy, autonomic nervous system dysfunction and carditis with acute heart failure are among rare manifestations as well as late generalised stage with myelitis. We present a case of a patient with meningoradiculitis, autonomic nervous dysfunction, respiratory failure due to phrenic nerve palsy and acute heart failure with systolic myocardial dysfunction. The diagnosis of Borrelia infection was confirmed by positive serological testing, appropriate response to antibiotic therapy and exclusion of other diseases. Our case suggests that in unexplained respiratory failure and acute systolic myocardial dysfunction, particularly associated with signs of meningoradiculitis, Borrelia infection should be included in the differential diagnosis.
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1 - 8 - 2013
12 - 6 - 2013
  • Department of Medical Intensive Care, University medical centre Maribor, Ljubljanska 5, SI-2000, Maribor, Slovenia
  • Department of Medical Intensive Care, University medical centre Maribor, Ljubljanska 5, SI-2000, Maribor, Slovenia
  • [1] Rizzoli A., Hauffe H.C., Carpi G., Vourc’h G.I., Neteler M., Rosa R., Lyme borreliosis in Europe. Euro. Surveill., 2011,
  • [2] Satz N., Klinik der Lyme-Borreliose, 2nd Edition., Verlag Hans Huber, Bern, 2002
  • [3] Stanek G., Wormser G.P., Gray J., Strle F., Lyme borreliosis, Lancet 2012, 379, 461–473[Crossref][WoS]
  • [4] Halperin J.J., Nervous system Lyme disease, Infect. Dis. Clin. N. Am., 2008, 22, 261–274[Crossref]
  • [5] Stanek G., Strle F., Lyme borreliosis: a European perspective on diagnosis and clinical management, Curr. Opin. Infect. Dis., 2009, 22, 450–454[Crossref]
  • [6] Steere A.C., Borrelia burgdorferi (Lymedisease, Lymeborreliosis), In: Mandell G.L., Bennet J.E., Dolin R. (Eds.), Principles and practice of infectious diseases, 5th Edition, Churchill Livingstone, Philadelphia, 2000
  • [7] Nau R., Christen H.J., Eiffert H., Lyme disease - Current state of knowledge, Dtsch. Artzebl. Int., 2009, 106, 72–82
  • [8] Wormser G.P., Dattwyler R.J., Shapiro E.D., Halperin J.J., Steere A.C., Klempner M.S., et al., The clinical assessment, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America, Clin. Inf. Dis., 2006, 43, 1089–1134[Crossref]
  • [9] Gray J., European Concerted Action on Lyme Borreliosis 2012,
  • [10] Faul J.L., Ruoss S., Doyle R.L., Kao P.N., Diaphragmatic paralysis due to Lyme disease, Eur. Respir. J., 1999, 13, 700–702[Crossref]
  • [11] Silva M.T., Sophar M., Howard R.S., Spencer G.T., Neuroborreliosis as a cause of respiratory failure, J. Neurol., 1995, 242, 604–607[Crossref]
  • [12] Ishaq S., Quinet R., Saba J., Phrenic nerve paralysis secondary to Lyme neuroborreliosis, Neurology, 2002, 59, 1810–1811[Crossref]
  • [13] Winterholler M., Erbguth F.J., Tick bite induced respiratory failure. Diaphragm palsy in Lyme disease, Intensive Care Med., 2001, 27, 1095[Crossref]
  • [14] Chatila R., Kapadia C.R., Intestinal pseudoobstruction in acute Lyme disease: a case report, Am. J. Gastro., 1998, 93, 1179–1180[Crossref]
  • [15] Gila L., Guerrero A., Astarloa R., Martí P., Gutiérrez J.M., Reflex sympathetic dystrophy. A new manifestation of Lyme disease?, Enferm. Infec. Microbiol. Clin., 1990, 8, 32–35
  • [16] Burman M., Nguyen H.L., Murthy V., Sen Gupta P., Davies C., Wragg A., et al., Severe orthostatic hypotension in a diabetic patient may not be due to diabetic autonomic neuropathy, Clin. Med., 2011, 11, 290–291[Crossref]
  • [17] Duray P.H., Histopathology of clinical phases of human Lyme disease, Rheum. Dis. Clin. North. Am., 1989, 15, 691–710 [PubMed]
  • [18] Huppertz H.I., Böhme M., Standaert S.M., Karch H., Plotkin S.A. Incidence of Lyme borreliosis in the Würzburg region of Germany, Eur. J. Clin. Microbiol. Infect. Dis., 1999, 18, 697–703[Crossref]
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