Abstract
OBJECTIVE: To report a case of painful small fiber neuropathy associated with Lyme disease, with resolution of pain following antibiotic treatment, in the absence of nerve regeneration.
BACKGROUND: Small fiber neuropathy may present with pain and a normal neurological examination. Lyme disease can be associated with cranial neuropathy, polyradiculopathy, plexopathy, polyneuropathy, or mononeuritis multiplex, but has not previously been reported with pure small fiber neuropathy.
DESIGN/METHODS: An 83 year old woman presented with a four year history of diffuse burning pain in her face, arms, and legs, and muscle spasms in the legs. Previous evaluations were unrevealing. At presentation the neurological examination and electrodiagnostic studies were normal. Skin biopsy was done to evaluate for small fiber neuropathy. Blood tests were ordered for known causes of neuropathy.
RESULTS: Skin biopsy showed significantly reduced epidermal nerve fiber density of 4.8 (nl>5.4) and sweat gland nerve fiber density 27.1 (nl>36.5) at the calf. The patient was seropositive for IgG anti-borrelia antibodies according to the CDC two-tier algorithm, including Western blot reactivity to p18, p28, p30, p39 (BmpA), p41 (FlaB), p58, p66, and p93 protein bands. In addition, there was positive IgG reactivity against p31 (OspA), p34 (OspB), p60, and recombinant VlsE proteins. Tests for other causes of neuropathy were negative. She was then treated with a 40 day course of oral antibiotics for Lyme disease with complete resolution of her neuropathic symptoms. Repeat skin biopsy at 5 months post treatment revealed persistently low epidermal and sweat gland nerve fiber densities.
CONCLUSIONS: Painful small fiber neuropathy may be a manifestation of Lyme disease. Antibiotic treatment of Lyme disease can result in resolution of the neuropathic pain symptoms. Response to treatment can occur in the absence of nerve regeneration. Further investigation is needed to understand the associated mechanism.
Disclosure: Dr. Feuer has nothing to disclose. Dr. Alaedini has nothing to disclose.
Thursday, March 21 2013, 7:30 am-12:00 pm
- Copyright © 2013 by AAN Enterprises, Inc.
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