A case of Lyme neuroborreliosis coexistent with T-cell lymphoma

Abstract

An 80-year-old Japanese man developed sensory disturbance of his extremities. One week after the onset of sensory disturbance, he also developed bilateral facial nerve palsy, weakness of the extremities, vesicorectal disturbance, general fatigue, and syndrome of inappropriate antidiuretic hormone secretion (SIADH). His symptoms worsened gradually. Despite the absence of apparent tick bite and characteristic skin lesions, we suspected Lyme neuroborreliosis (LNB) because of pleocytosis and elevated protein levels in the cerebrospinal fluid (CSF), in addition to the aforementioned symptoms. After combined administration of antibiotics and steroids, his symptoms improved rapidly. CSF showed highly elevated levels of the chemokine CXCL-13 and his serum was positive for IgM against Borrelia afzelii. Therefore, we diagnosed him as having LNB. He developed an exacerbation of SIADH and generalized fatigue during the course of LNB. His condition deteriorated despite further administration of antibiotics and steroids. Bone marrow aspiration revealed the presence of medium- to large-sized atypical lymphoma cells and lymphoma cells positive for CD8 but negative for CD45. Therefore, we diagnosed T-cell lymphoma. In recent years, an association between Borrelial infection and lymphoma development has been suspected. Borrelia afzelii infection may have been involved in the development of T-cell lymphoma in this case.