Abstract:
Return of muscle strength and function after use of
intravenous immunoglobulin for Lyme
disease-associated acute demyelinating
polyneuropathy
CIDP SUPPORT GROUP
09-26-2003
Arch Phys Med Rehabil. 2003 Sep;84(9):E34-E35.
Cynthia Majerske, MD (University of Pittsburgh,
Pittsburgh, PA);
Patient: A 58-year-old man with babesiosis and Lyme
disease.
Case Description: The patient, who had a history of
splenectomy, was admitted with diffuse myalgias,
fevers, and chills. He had a history of foreign and
domestic travel 6 weeks prior. He was diagnosed with
babesiosis.
The
patient's muscle strength on admission was 5/5
throughout, but declined during his acute care stay.
The patient was transferred to the acute
rehabilitation floor, where he demonstrated noted
weakness primarily in the lower extremities.
Through his first week of rehabilitation, he became
significantly weaker in hip flexors and knee
extensors (to 2+/5) as well as developed proximal
upper-extremity weakness (to 3+/5) for shoulder
flexion. An electromyogram (EMG) on day 14 showed
primary demyelinating sensorimotor polyneuropathy.
Sural nerve biopsy was unremarkable. Western blot
for Lyme disease returned positive. He was started
on intravenous Ceftriaxone, yet deterioration of
muscle strength and function was noted.
An
EMG on day 30 showed continued evidence of
demyelinating polyneuropathy with significantly
prolonged F-wave latencies in the upper extremities
and moderate worsening in conduction velocities in 3
of 4 nerves. He was started on intravenous
immunoglobulin (IVIG) on day 33 and received a total
of 5 doses over 5 days.
Assessment/Results: Patient was discharged on day 38
with improving muscle strength and he was able to
ambulate 150ft using a wheeled walker with
supervision. At follow-up 8 weeks later, muscle
strength had fully returned.
Discussion: This case illustrates that Lyme
disease-associated demyelinating polyneuropathy may
be treated with IVIG. The potential use of IVIG in
this population is based on its efficacy in those
with acute demyelinating neuropathy of alternative
etiologies.
Conclusion: IVIG can be considered as a treatment
option for demyelinating polyneuropathy associated
with Lyme disease.
PMID: 13680780 [PubMed - as supplied by publisher]
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