Transverse Myelitis and Guillain-Barré Syndrome Associated with Cat-Scratch Disease, Texas, USA, 2011
Emerg Infect Dis. 2018 Sep; 24(9): 1754–1755.
We describe a case of coexisting transverse myelitis and Guillain-Barré syndrome (GBS) related to infection with Bartonella henselae proteobacterium and review similar serology-proven cases. B. henselae infection might be emerging as a cause of myelitis and Guillain-Barré syndrome and should be considered as an etiologic factor in patients with such clinical presentations.
This case study is of a previously healthy 10 year old girl who presented with lower extremity weakness, abdominal pain, vomiting, urinary retention, lymphadenopathy, headache, neck pain, lower back pain, burning in wrists, knees, ankles, and feet, and increases sensitivity to pain in her legs.
She had evidence of myelitis, brain lesions, and peripheral nerve involvement.
They administered rifampin and doxycycline for a possible CSD (Cat Scratch Disease) diagnosis but had to discontinue rifampin due to rising liver enzyme levels. She was then given IV immunoglobulin for possible GBS (Guillain Barre Syndrome) and showed tremendous improvement with resolution of urinary retention and decrease in pain & weakness. Four months later she had only residual sensory deficits.
According to the study, by 1971, 40 cases of Bartonella with neurological complications occurred with 90% involving encephalitis with a few myelopathy. Other CSD associated myelitis cases and other GBS-associated Bartonella cases have been reported.
Studies of the efficacy of treatments for CSD-associated neurologic manifestations are lacking, and thus, the optimal regimen and duration of therapy are unknown. However, we suggest that clinicians consider CSD early in disease courses involving neurologic complications; the possibility of GBS, myelitis, or both in the setting of possible CSD should prompt clinicians to initiate antimicrobial treatment early and consider steroid or intravenous immunoglobulin therapy to prevent progression of disease.
For Lyme/MSIDS patients with these presentations, steroids would be counter-indicated due to the immune suppression which would enhance pathogen involvement: http://www.lymenet.de/literatur/steroids.htm
“It is interesting to note that in dogs who had Lyme disease, injections of dexamethasone, a corticosteroid, enabled Borrelia burgdorferi to be cultured from blood drawn on the following day.”
This was done by Dr. Elizabeth Burgess at the University of Wisconsin. This suggests that the steroid suppresses a mechanism for keeping the bacteria out of the circulatory system, since ordinarily it is difficult to grow the Lyme organism from the blood. Entrance of the bacteria into the bloodstream can allow seeding of other organs.
“In conclusion, the decision to use the steroids in a Lyme patient must be given considerable thought and the possible benefits must be weighed against the risks. I would not use steroids unless the patient was also on antibiotics.“
Please keep in mind the difference between catabolic (break down) steroids and anabolic (build up) steroids.