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Infect Dis Rep. 2014 Dec 11;6(4):5496. doi: 10.4081/idr.2014.5496. eCollection 2014 Nov 19.

A case of chronic progressive lyme encephalitis as a manifestation of late lyme neuroborreliosis.

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Department of Medicine, University of Pittsburgh Medical Center , PA, USA.
Division of Neurology, University of Pittsburgh Medical Center , PA, USA.
Department of Medicine, University of Pittsburgh Medical Center , PA, USA ; Division of Infectious Diseases, University of Pittsburgh Medical Center , PA, USA.


A 54-year-old female living in Europe presented with gait ataxia, dizziness, and bilateral hearing loss. Magnetic resonance imaging (MRI) revealed non-specific white matter changes. The patient's condition gradually deteriorated over two years without diagnosis. The patient continued to decline cognitively and neurologically with worsening ataxia and upper motor neuron signs. Repeat MRI showed worsening white matter changes. Lumbar puncture, not previously done, showed positive Lyme testing. Treatment with intravenous ceftriaxone resulted in marked neurological improvement. Four years after symptom, the patient has short-term memory deficits and chronic fatigue, but is otherwise neurologically, cognitively, and functionally intact. Follow up MRI findings remain largely unchanged. Because cases of intraparenchymal or encephalopathic neuroborreliosis in America are lacking, so are treatment options. We present a rare case and discuss our experience with antibiotic treatment. This case lends evidence to define optimal treatment of this disease, imperative for hastening neurological recovery.


Borrelia burgdorferi; Lyme neuroborreliosis; encephalopathy

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