Is this a new manifestation of Lyme disease? No, Bannwarth syndrome was first described in Europe in the 1800's. Borrelia garinii is responsible for symptoms of Lyme neuroborreliosis in Europe with associated neuropathic pain syndromes, and Borrelia burgdorferi sensu stricto is the primary form of Borrelia found in the United States which causes this syndrome. The severity of the clinical manifestations will depend on the species of borrelia, length of the infection, the patient’s co-infection status and genetic makeup (HLA status), apart from other overlapping factors on the 16 point MSIDS map driving inflammation.
This article is a good reminder of the various clinical manifestations pointing to an infection with borrelia, and the need for proper treatment of an EM rash. Patient one in the case series only took 5 days of doxycycline before developing this syndrome. Dr Gary Wormser published an article in Antimicrobial Agents and Chemotherapy in the 1990s that compared doxycycline and Ceftin in treating early Lyme disease. He demonstrated that up to 20 percent of patients did not adequately respond to this treatment (for 30 days) and went on to develop chronic symptomatology especially when they had central nervous system symptoms (stiff neck, headaches, light and sound sensitivity, cognitive issues) or peripheral nervous system symptoms (tingling, numbness, burning sensations of the nerves). The article that Dr Freeman and I recently published in the International Journal of General Medicine (Empirical validation of the Horowitz Multiple Systemic Infectious Disease Syndrome Questionnaire for suspected Lyme disease; International Journal of General Medicine 2017:10 249–273) also highlighted the importance of migratory pain (muscle, joint and nerve pain) as a potential marker of an infection with Lyme disease. One of the important take home messages from this article therefore is: treat EM rashes aggressively to prevent long term disability, and suspect Lyme disease in anyone with sudden onset of nerve pain, paresthesias or weakness with neurological dysfunction in the setting of a multisytemic illness.
