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A case of Lyme neuroborreliosis coexistent with T-cell lymphoma.


Senior Member
A case of Lyme neuroborreliosis coexistent with T-cell lymphoma.

Nagata R1, Inamori Y, Takata Y, Ikeda K, Watanabe O, Takashima H.
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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.


Just wanted to quickly add as well that different varieties of borrelia can present with different symptoms, and there has been some talk as well concerning symptom presentation varying according to patient sex.

Though it's been a while since I searched, some years ago I found a number of cases where patients had traveled abroad only to return home with infection by a variety of borrelia not recognized by doctors in their home region.

Until recently, the country where I live didn't even acknowledge North American varieties in their State-governed system. There is now a very very slight reference to such differences burried in a long document - but it's still not included in the general diagnostic guidelines (to my knowledge).

This especially concerns me because I was affected by this negligent policy. Thus far, EVERY government agency (and journalist) to whom I have reported this problem (over a period of several years now) has COMPLETELY ignored me - willful ignorance.

I submitted medical-journal references about borrelia aquired aboad where at least one patient died. I also submitted official census records which detail how many citizens travel to borrelia hot-spots each year, plus information from an EU country which describes incidents of borrelia acquired abroad.

Thus far (since 2009) though, it's all been ignored. My impression is that it's heresy to question State protocol.