Alexandru Crişan 1, Ruxandra Laza 1
1 Infectious Diseases Clinic II – University of Medicine and Pharmacy “Dr. V. Babeş” Timişoara
Abstract
Lyme disease is caused by Borrelia burgdorferi and it manifests as a localized infection of the skin (erythema migrans), followed by heart, joints and nervous system involvement. Seventh nerve palsy is by far the most common. The authors present the case of a 19-year-old female who developed low grade fever, aseptic meningitis and facial palsy and was admitted to the Clinical Hospital of Infectious Diseases and Pneumophtysiology “Dr. Victor Babeş” Timişoara. Diagnosis of Lyme borreliosis was established by serologic testing (ELISA) that revealed high titers of IgM and IgG. Clinical outcome was good after treatment with ceftriaxone. Changes of biological features, diagnosis and differential diagnosis difficulties and peculiar aspects of evolution are presented. In the presented case the incubation period was longer than usual, the chronic migratory erythema was absent and the patient remembered the tick bite very late. The clinical course was dominated by symptoms of upper respiratory tract infection, serous meningitis and Bell palsy. Lyme disease must be kept in mind in the differential diagnosis of aseptic meningitis and facial palsy as it can be the first and only sign of disease.