Bannwarth syndrome in early disseminated Lyme disease
Welcome to another Inside Lyme Podcast with your host Dr. Daniel Cameron. In this episode, Dr. Cameron will be discussing the case of a 66-year-old man with Bannwarth syndrome with urinary retention in early Lyme disease.
Omotosho and colleagues described this case in an article entitled “A Unique Case of Bannwarth Syndrome in Early Disseminated Lyme Disease.”¹
The man presented to the emergency room with generalized myalgia, fatigue, and severe neck pain. The symptoms had been occurring for two weeks and began shortly after he was bitten by two ticks while performing yard work.
The patient reported having dull mid-back pain, intermittent headaches, and neck stiffness. His doctor initially suspected he had pneumonia and prescribed an antibiotic. But his symptoms worsened.
“His pain then radiated down his entire spine into his upper and lower extremities, leading to right arm weakness and new urine retention onset,” the authors wrote.
“His paraspinal tenderness and diminished deep tendon reflexes bilaterally.” His pain score was 8 out of 10. The ESR rate was 100 and C-reactive protein of 8.8 mg/L.
“Physicians need to be aware of the rare neurological manifestations of [Lyme neuroborreliosis] … Prompt diagnosis and treatment with antibiotics can reduce unnecessary imaging, patient anxiety, and, most importantly, avert debilitating complications.”
Test results indicated a white blood cell count of 12 k/uL, C-reactive protein of 8.8 mg/L, sedimentation rate of 100 mm/h, and creatinine kinase of 27 units/L.
Western blot and ELISA Lyme disease tests were positive and confirmed an early stage infection with Borrelia burgdorferi. In addition, a spinal tap showed lymphocytic pleocytosis and a positive Lyme disease titer.
The man was diagnosed with Bannwarth syndrome (BWS) based on his severe radiculopathy, upper extremity weakness, and urinary dysfunction. “All of these findings are pathognomonic for [Bannwarth syndrome],” wrote the authors.
Typically, Bannwarth syndrome affects a person’s limbs. In this case, Lyme disease induced sacral radiculitis leading to neurogenic urinary dysfunction.
The authors were not sure why the patient’s urinary tract was affected. They suggested, “the influence of the radiculitis on innervating fibers” and “direct invasion of the spirochetes into the bladder wall” might have played a role.
“Early recognition of this rare presentation associated with Lyme disease and treatment with antibiotics can prevent disease progression and detrimental neurological sequelae.”
The man was treated with a 21-day course of IV ceftriaxone and “his symptoms improved with complete resolution of his urinary retention,” the authors wrote.
About Bannwarth syndrome
Bannwarth syndrome has been reported most often in Europe. And despite disputes over its incidence in the United States, “the condition does occur but is often misdiagnosed.”
BWS is characterized by a wide range of symptoms including:
- radicular pain (100%)
- sleep disturbances (75.3%)
- headache (46.8%)
- fatigue (44.2%)
- malaise (39%)
- paresthesia (32.5%)
- peripheral nerve palsy (36.4%)
- meningeal signs (19.5%)
- paresis (7.8%)
The syndrome can cause severe pain. “BWS typically manifests itself with severe zoster-like segmental pain that is worse at night,” the authors wrote. “The pain has a burning, stabbing, biting, or tearing character and usually responds poorly to all common analgesics.”
“The constellation of neurological symptoms, particularly when associated with a recent or suspected tick bite in an endemic region, should prompt thorough evaluation for [Lyme neuroborreliosis] and assessment for BWS,” the authors wrote.
The following questions are addressed in this Podcast episode:
- What is Bannwarth syndrome?
- How is BWS diagnosed and treated?
- What is radicular pain?
- What is the significance of the spinal tap findings?
- What is the significance of an elevated sedimentation rate and c-reactive protein?
- Why is BWS rarely diagnosed in the USA?
- What can we learn from this case?
Thanks for listening to another Inside Lyme Podcast. Please remember that the advice given is general and not intended as specific advice to any particular patient. If you require specific advice, please seek that advice from an experienced professional.
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- Omotosho YB, Sherchan R, Ying GW, Shayuk M. A Unique Case of Bannwarth Syndrome in Early Disseminated Lyme Disease. Cureus. Apr 25 2021;13(4):e14680. doi:10.7759/cureus.14680