Dados do Trabalho

Título

BRAZILIAN LYME-LIKE DISEASE: A DIAGNOSTIC CHALLENGE

Apresentação dos casos

A 2-year-and-8-month-old girl from Pernambuco, with no significant medical history, presented with fever following a tick bite, followed by arthralgia and arthritis in the right knee, which then spread to other large joints. The child refused to walk, cried intensely, and appeared unstable when attempting to stand, with no muscle weakness or cerebellar ataxia. During hospitalization in São Paulo, rheumatological and neoplastic causes were ruled out. Neurological examination revealed difficult-to-obtain patellar reflexes. Initial cerebrospinal fluid (CSF) analysis showed hyperproteinorrachia; blood tests and MRIs of the hip and knees were normal. MRI of the neuroaxis showed thickening and gadolinium enhancement in nerve roots up to T11. After two months without improvement, a Lyme-like phenotype was suspected. Borrelia serology was negative, leading to empirical treatment with Ceftriaxone for 21 days, resulting in complete resolution of symptoms.

Discussão

Lyme Disease (LD) is a zoonosis found in the US, transmitted by ticks and caused by spirochetes of the Borrelia burgdorferi complex. In Brazil, it is known as Brazilian Lyme-like Disease or Baggio-Yoshinari Syndrome, caused by spirochetes similar to Mycoplasma spp and Chlamydia spp, transmitted by Amblyomma cajennense and Ixodes loricatus ticks. In the acute phase, fever, myalgia, arthralgia, and headache are common, often with erythema migrans (50% of cases). If untreated, it can lead to complications like cutaneous recurrences, and neurological, articular, and cardiac issues, with neurological and articular complications in 35% of Brazilian cases. Neurological complications include lymphocytic meningitis, cranial neuritis, peripheral radiculopathy, Guillain-Barré syndrome, and encephalitis.
Diagnosis is made by ELISA with American Borrelia burgdorferi antigen, and CSF antibody testing can be helpful but has similar limitations to serological studies. Treatment varies by disease stage: primary infection is treated with doxycycline; neurological or rheumatological complications with ceftriaxone.

Comentários finais

The Brazilian Lyme-like phenotype is underreported due to diagnostic challenges and limited access to tests. This case demonstrates a patient with clinical and epidemiological features compatible with Lyme-like disease and a positive response to treatment despite negative serology, highlighting the need for improved diagnostic tests and increased awareness of this tick-borne zoonosis.

Referências

Yoshinari NH, Oyafuso LK, Monteiro FG, de Barros PJ, da Cruz FC, Ferreira LG, Bonasser F, Baggio D, Cossermelli W. Doença de Lyme. Relato de um caso observado no Brasil [Lyme disease. Report of a case observed in Brazil]. Rev Hosp Clin Fac Med Sao Paulo. 1993 Jul-Aug;48(4):170-4. Portuguese. PMID: 8284588.

Palavras Chave

lyme; disease; neuroinfection