目的:一名80岁男性患者主诉左腿近端轻瘫,左腹部疼痛和感觉障碍,左下腹部出现放血,coprostasis,严重的腹痛,以及他的一般状况在几周内逐渐恶化。该患者已经去过其他三个医疗中心。结肠镜检查和腹部计算机断层扫描不能解释明显的症状。此外,左腿有急性电梯轻瘫,躯干两侧有严重的瘙痒性皮疹。
方法:在汉堡兰肯豪斯(IKH),尿液的实验室参数,凳子,和血,超声,心电图,经胸超声心动图诊断未见异常。食管胃十二指肠镜检查显示斑片状红斑和中度慢性低活动性螺杆菌阳性胃炎。结肠镜检查,两个息肉被切除。磁共振成像和神经电图的神经系统检查也显示出正常的发现。自身免疫性或类风湿疾病的证据也不存在。最后,脑脊液分析显示淋巴细胞粒细胞计数(32/3淋巴细胞,21/3粒细胞)和升高的疏螺旋体特异性IgG指数(Ai)为20.82。这一发现得到了补充血清学诊断的证实,其中检测到疏螺旋体特异性IgM和IgG抗体。总之,Bannwart综合征被认为是神经症状的原因。21天的borreliosis治疗包括多西环素给药,并根据需要使用novaminsolifone和普瑞巴林进行镇痛。
结论:腿部轻瘫的复杂症状,下腹部疼痛和感觉障碍,exanthema,并发现与长期不良的一般状况相结合是非典型神经性伯氏病患者的后果。
OBJECTIVE: An 80-year-old male patient had complained of proximal paresis of the left leg, pain and sensory disturbances in the left abdomen, exanthema in the left lower abdomen, coprostasis, and severe abdominal pain, as well as a progressive deterioration of his general condition for weeks. The patient had already presented to three other medical centers. Colonoscopy and computed tomography of the abdomen could not explain the pronounced symptomatology. In addition, there was acute elevator paresis of the left leg and severe pruritic rash on both sides of the trunk.
METHODS: At the Israelitisches Krankenhaus Hamburg (IKH), laboratory parameters of urine, stool, and blood, ultrasound, electrocardiogram, and transthoracic echocardiography diagnosis showed no abnormalities. Esophago-gastro-duodenoscopy revealed patchy erythema and moderately severe chronic low-activity Helicobacter-positive gastritis. Colonoscopically, two polyps were ablated. A neurological examination with magnetic resonance imaging and electroneurography also showed normal findings. Evidence of autoimmune or rheumatoid disease was also absent. Finally, analysis of the cerebrospinal fluid revealed a lympho-granulocytic cell count (32/3 lymphocytes, 21/3 granulocytes) and an elevated Borrelia-specific IgG index (Ai) of 20.82. This finding was confirmed by a complementary serological diagnosis, in which Borrelia-specific IgM and IgG antibodies were detected. In sum, Bannwart\'s syndrome was assumed to be the cause of the neurological symptoms. The 21-day borreliosis therapy included doxycycline administration and analgesia with novaminsulfone and pregabalin as needed.
CONCLUSIONS: A complex symptomatology of leg paresis, lower abdominal pain and sensory disturbances, exanthema, and coprostasis in combination with a long-lasting poor general condition were found to be the consequences of atypical neuroborreliosis.