Excerpt:

Several infectious agents may cause arthritis or arthropathy. For example,
infection with Borrelia burgdorferi, the etiologic agent of Lyme disease,
may in the late phase manifest as arthropathy. Infections with
Campylobacter, Salmonella or Yersinia may result in a postinfectious
reactive arthritis. Acute infection with parvovirus B19 (B19V) may likewise
initiate transient or chronic arthropathy. All these conditions may be
clinically indistinguishable from rheumatoid arthritis. Here, we present
evidence that acute B19V infection may elicit IgM antibodies that are
polyspecific or cross-reactive with a variety of bacterial antigens. Their
presence may lead to misdiagnosis and improper clinical management,
exemplified here by two case descriptions. Further, among
33 subjects with proven recent B19V infection we found IgM-enzyme immuno
assay
(EIA) positivity for Borrelia only, for Borrelia and Salmonella, for
Borrelia and Campylobacter, and for Borrelia, Campylobacer and Salmonella in
26 (78.7%),
1 (3%), 2 (6%), and 1 (3%), respectively, however, examined by Borrelia
LineBlot all samples were negative. These antibodies persisted over 3 months
in 4/13
(38%) patients tested. Likewise, in a retrospective comparison of the
results of a diagnostic laboratory, 9/11 (82%) patients with confirmed acute
B19V infection showed IgM to Borrelia. However, none of 12 patients with
confirmed borreliosis showed any serological evidence of acute B19V
infecion. Our study demonstrates that recent B19V infection can be
misinterpreted for secondary borreliosis or enteropathogen-induced reactive
arthritis. To perceive correct diagnosis we emphasize caution in
interpretation of polyreactive IgM and exclusion of recent B19V infection in
patients examined for infectious arthritis or arthropathy. 

We report the case of a 30-year-old man who developed severe
dysphagia owing to neuroborreliosis. He showed dysphagia,
diplopia, hiccups, and walking difficulty Neurological
examination revealed mild disturbance of consciousness, diplopia
on left lateral gaze, left-side-dominant blephaloptosis,
gaze-evoked horizontal nystagmus on left lateral gaze, mild
bilateral muscle weakness, palatoplegia, dysphagia, dysarthria,
and truncal ataxia An increased pharyngeal reflex caused
dysphagia in this patient. An EEG revealed intermittent high
amplitude slow wave activity. However, head MRI, blood count,
serum chemistry, and cerebrospinal fluid examination showed no
abnormality. Initially, brainstem encephalitis with unknown
etiology was diagnosed. The hiccups, diplopia, and ptosis were
improved by corticosteroid therapy, but other symptoms were
refractory to corticosteroid therapy and IVIg.

Excerpt:

PURPOSE: To report a rare case of Lyme disease with
neuroretinitis from South India.
MATERIALS AND METHODS: Retrospective case report. A 45-year-old
lady who hails from the Nagarhole forest in South India presented
with a history of tick bite followed by diminution of vision in
the left eye. Fundus evaluation of the left eye showed
neuroretinitis. Mantoux test, Treponema pallidum hemagglutination
test, serum angiotensin converting enzyme, and ELISA for
toxoplasmosis and rickettsial infections were negative. ELISA for
Lyme disease was positive for IgM antibodies. This was confirmed
by Western blot test.

RESULTS: Ocular inflammation resolved with a course of doxycyline
and oral steroids. The species of the tick was also identified.
CONCLUSION: This case
highlights the need to consider Lyme disease, though rare in
India, in the differential diagnosis of neuroretinitis especially
if the patient hails from a forest area.