Peripheral neuropathy due to neuroborreliosis: Insensitivity for CXCL13 as early diagnostic marker

The case of a 69-year-old woman with peripheral neuropathy caused by Lyme neuroborreliosis (LNB) in an endemic region Eastern Austria is reported. patient had noticed transient numbness her left leg. On initial examination, she patchy sensory disturbances the lower leg, but ancillary examinations nerve conduction and cerebrospinal fluid (CSF), including B-cell chemokine CXCL13, were normal. A re-tap performed 54 days later, following clinical progression foot drop, widespread leg paresthesia, pain, revealed increased cell count, autochthonous IgM production, synthesis Borrelia-specific IgM, elevated CXCL13. Neurophysiological disclosed incomplete block, mixed axonal demyelinating sensorimotor neuropathy, subacute neurogenic damage muscles innervated peroneal nerve. This study presents rare evidence very early diagnostic findings LNB. These are characterized insensitivity CXCL13 CSF to aid earlier diagnosis development intrathecal immune response against Borrelia at later stage. reinforce need for confirm facilitate appropriate treatment this manifestation