Neuroborreliosis: diagnostic problem in distinguishing from multiple sclerosis

Objectives: To present the importance of additional diagnostic procedures in diff erential diagnosis of multiple sclerosis and neuroborreliosis, exemplifi ed by a case of our patient. Neurological manifestation of Lyme disease varies and sometimes can imitate multiple sclerosis, especially in the early disseminated or late phase when there are no data on clinical infection. Case report: We present a patient with neuroborreliosis, initially considered as multiple sclerosis. Positive serology for Borrelia burgdorferi is an indicator of a past infection. However, the presence of specifi c IgG and IgM antibodies in the CSF confi rms the diagnosis. In our case, magnetic resonance imaging (MRI) of the brain showed normal fi ndings, whereas during spinal cord MRI, edema and hyperintense lesions of the thoracic spinal cord were found. Visually evoked potentials revealed prolonged latencies of the P wave on the left side. CSF analysis showed proteinorrhachia and distinct pleocytosis, with positive serology for specifi c antibodies to Borrelia burgdorferi. Conclusion: Th e clinical symptoms, MRI and CSF fi ndings in combination with good response to antibiotic therapy confi rmed the diagnosis of neuroborreliosis.