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Lyme Neuroborreliosis in a Patient with Breast Cancer: MRI and PET/CT Findings

Department of Infectious Diseases, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark
Department of Radiology, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark
Author to whom correspondence should be addressed.
Diagnostics 2020, 10(1), 36;
Received: 6 November 2019 / Revised: 5 January 2020 / Accepted: 6 January 2020 / Published: 9 January 2020
(This article belongs to the Section Medical Imaging)
We present a case demonstrating the performance of different radiographical and nuclear medicine imaging modalities in the diagnostic work-up of a patient with Lyme neuroborreliosis. The patient presented in late summer 2019 with radicular pains followed by a foot drop and peripheral facial palsy, both right-sided. Due to a history of breast cancer, disseminated malignant disease was initially suspected. Bone metastasis was ruled out by skeletal scintigraphy. Magnetic resonance imaging (MRI) of the neuroaxis and a whole body 18F-FDG PET-CT was performed within 48 hours. The MRI revealed a strong contrast enhancement of the conus medullaris and fibers of the cauda equina, while the 18F-FDG PET/CT was without pathological findings. Examination of cerebrospinal fluid led to the definitive diagnosis of Lyme neuroborreliosis with monocytic pleocytosis and a positive intrathecal test for Borrelia burgdorferi. The patient became pain-free after 10 days of ceftriaxone, and the paralysis slowly regressed the following month. This case highlights the difficulty of the diagnosis of Lyme neuroborreliosis and discusses the relevant imaging findings. View Full-Text
Keywords: MRI; 18F-FDG PET/CT; lyme neuroborreliosis MRI; 18F-FDG PET/CT; lyme neuroborreliosis
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MDPI and ACS Style

Ørbæk, M.; Klausen, C.; Lebech, A.-M.; Mens, H. Lyme Neuroborreliosis in a Patient with Breast Cancer: MRI and PET/CT Findings. Diagnostics 2020, 10, 36.

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