Walking the Razor’s Edge: A Crossover Between Infection and Malignancy
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Publication Date
2025
Abstract
Background: . • Lyme disease is a multisystem infection caused by the spirochete species Borrelia. The most common subspecies seen in the United States is Borrelia Burgdorferi6-7 • 10-15% of infections seen in the United States have neurologic involvement, known as neuroborreliosis4 • Presenting symptoms often include unilateral or bilateral facial nerve palsy, but patients may also have focal weakness and/or polyradiculitis4, 6-7 • Lumbar puncture in neuroborreliosis demonstrates lymphocytic pleocytosis • The above combination of neurologic and diagnostic findings are also seen in presentations of primary or secondary CNS lymphoma10, 12- Case Presentation: • 62-year-old woman with a history of POT1 mutation presents with 3 weeks of increasing neurologic symptoms including headache, bilateral CN VII palsies, and now focal weakness and paresthesias • Symptoms started after a road trip back to Oregon from the East coast where she had been camping during the summer • Initially presented with unilateral CN VII palsy and arm pain • She had been hospitalized two times in the last two weeks related to symp-toms without any conclusive explanation Physical Exam Findings • Bilateral CN VII palsies leading to inability to close either eye fully, move mouth normally • Focal weakness in proximal L arm, proximal L leg • Paresthesias in dermatomal distributions including T10, L2, L3 that were painful when elicited by palpation Hospital Course • Imaging and lumbar puncture completed which showed atypical lymphocytes • Started on empiric antibiotic therapy with ceftriaxone • Flow cytometry concerning for B cell lymphoma, however Lyme antibody titers returned positive in CSF • Patient declined any treatment for lymphoma, neurologic symptoms slowly improved with antibiotics alone • Discharged with close oncology and infectious disease follow-up
Specialty/Research Institute
Graduate Medical Education
