Pemphigoid gestationis is a skin-specific autoimmune disorder that can sometimes present as the cutaneous manifestation of a multiorgan disease due to potentially common pathogenic mechanisms. We report a severe form of pemphigoid gestationis in a 32-year-old primigravida woman, who presented at 22 weeks of gestation with headaches and blurred vision, later developing encephalitis, intrauterine fetal demise and dilated cardiomyopathy.
Introduction: Neuroborreliosis (NB) is a bacterial infection with Borrelia burgdorferi (Bb), targeting the peripheral and/or central nervous system. It appears on the secondary and tertiary phase of its evolution. Observation: T.M is a 40 years-old man, previously healthy. He presented 7 days before his admission, a facial asymmetry, with swallowing disorders. These signs were evolving rapidly during a stay in a village. There was no history of migrant erythema, tick's spot, or fever. The clinical examination found a right peripheral facial palsy (PFP), hypoesthesia on the territory of the right Vth cranial nerve and hypokinesia of the right soft palate with dulled gag reflex. The clinical syndrome was unilateral cranial polyneuritis. The cerebral MRI showed a Gado enhancement of the right facial nerve above his emergence from the protuberance. The cerebro-spinal fluid (CSF) study found lymphocytic meningitis (14 Lymphocytes/mm3) with elevated CSF protein (0, 6 g/l). Exhaustive para clinical tests were performed and went negative. The Borreliosis serology was positive to IgM and negative to IgG, with specific antiborrelia immunoglobulin intrathecal synthesis. The patient was treated by Ceftriaxone 2g / 24h during 14 days. The evolution was favorable, with partial regression of the PFP, and the control of the intrathecal immunoglobulin synthesis was negative. Discussion: Lyme borreliosis is the most frequent ixodid tick-borne human disease in the world, with an estimated 85,500 patients annually. It is a multi-systemic disease caused by Borrelia burgdorferi sensu lato. A complete presentation of the disease is an extremely unusual observation, in which a skin lesion follows a tick bite, the lesion itself is followed by heart and nervous system involvement, and later on by arthritis; late involvement of the eye, nervous system, joints and skin may also occur. We reported an early Lyme neuroborreliosis case with atypical unilateral painless cranial meningo-polyneuritis. The diagnosis was confirmed biologically with favorable clinical and biological evolution after antibiotic treatment. Conclusion: The absence of Tick, classical migrant erythema or painful meningopolyneuritis did not exclude neuroborreliosis diagnosis. In presence of LNB suggestive neurological syndrome, the detection of specific antibody in blood and CSF stay the mainstay for diagnosis of the disease.
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