A Case Report of Bannwarth Syndrome, a Presentation of Lyme Disease that's Becoming More Prevalent in the US.
Document Type
Conference Proceeding - Restricted Access
Publication Date
5-9-2025
Abstract
Lymphocytic meningoradiculitis, also known as Bannwarth Syndrome (BWS), is a unique presentation of neuroborreliosis as it presents as a radicular neuralgia with lymphocytic pleocytosis on cerebrospinal fluid and frequently with unilateral or bilateral facial paresis. Most reported cases of this disease occurred in the summer months, mostly in Europe. We report this case to shed the light on this under-reported and unique presentation of neuroborreliosis to consider testing for Lyme disease even in the absence of the typical Erythema migrans rash.
A 60-year-old female presented with confusion and worsening back pain radiating to both legs, muscle cramps, and bitemporal headaches, following a history of tick bites. Neurological examination showed bilateral hip flexion weakness (4/5) and diminished lower extremity reflexes. Lyme serology was reactive, and MRI revealed diffuse enhancement of the cauda equina and leptomeningeal enhancement, particularly in the thoracic spine. The patient was initially treated with Ceftriaxone and ganciclovir due to concerns for viral infections, but treatment was switched to Doxycycline after positive serum Lyme IgM results. On day 6, she developed right lower motor neuron facial nerve palsy. Patient was started on escalating gabapentin doses for severe back pain. CSF analysis revealed pleocytosis (270) with lymphocytic predominance, elevated protein (274), normal glucose (63), and positive Lyme CSF IgG. HSV, VZV, and CMV tests were negative, indicating a diagnosis of BWS.
Although more prevalent in Europe, BWS is becoming more common in the US. Two other similar cases presented to our facility within two weeks of this case. Physicians need to be aware about this unique presentation of neuroborreliosis since it can present in the absence of the typical rash. Pain management should be considered for these patients as it can be associated with sever neuropathic pain.
Recommended Citation
Al Asaad K, HajAissa N, Abdallah A, DeJesus Brazitis M. A case report of Bannwarth syndrome, a presentation of Lyme disease that's becoming more prevalent in the US. Presented at: Research Day Corewell Health West; 2025 May 9; Grand Rapids, MI.
Comments
2025 Research Day Corewell Health West, Grand Rapids, MI, May 9, 2025. Abstract 1707