Ceftriaxone and Doxycycline induced Seroconversion in Previously Seronegative Patient with Clinically Suspected Disseminated Lyme Disease: Case Report

Abstract

We present a case of middle-aged woman whose health problems began 3 months after a registered tick bite in endemic area of Lyme borreliosis. First symptoms included fatigue, chills, cervical lymphadenopathy, neck pain and stiffness. Patient was afebrile. Lyme disease was excluded due to lack of erythema migrans and negative enzyme immunoassay test results for anti- Borrelia antibodies. During the next few months, her condition was getting worse and symptoms were accompanied with brain fog, dizziness, palpitations, irregular menstrual cycles, insomnia, panic attacks, headaches, and muscle aches. This led to multiple medical tests and examinations, but the diagnosis failed to be established. Finally, after occurrence of paresthesia and weakness of leg muscles, clinical diagnosis of disseminated Lyme borreliosis with nervous system involvement was suspected and antibiotic therapy was initiated. After the second dose of ceftriaxone, patient got fever and her condition worsened. However, ceftriaxone therapy was continued for a total of 5 days and was followed by 4 weeks of doxycycline therapy. Upon completion of antibiotic therapy, high specific anti- Borrelia antibodies were detected by Western blot and SeraSpot. Appearance of anti- Borrelia antibodies, in contrast to negative test results performed immediately before the therapy started, indicated seroconversion. 18 months after the therapy, patient was completely without the symptoms. This paper emphasizes importance of clinical evaluation of Lyme disease and shows a unique case of seroconversion in patient with symptoms of disseminated Lyme disease. Seroconversion was likely triggered by release of lipoproteins and other immunogenic molecules from Borrelia once the bacterial die-off began due to antibiotic therapy.

Scrutinizing Clinical Biomarkers in a Large Cohort of Patients with Lyme Disease and Other Tick-Borne Infections

“…At both T0 and T2, serologically negative patients had abnormal clinical markers ( Figure 2 and Table 3 ). Other studies have also demonstrated that patients with TBIs may have delayed or no seroconversion [ 22 , 26 , 27 ]. TBIs can cause immune dysfunction that might prevent an effective B cell response [ 17 ].…”

“…Current methods to diagnose Lyme disease and other TBIs can be insufficient [ 11 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 ]. Lyme disease diagnosis is supported by patient history, clinical examination findings, and completing serology tests [ 11 , 23 , 24 , 25 ].…”

“…However, patients often cannot remember receiving tick bites or do not develop a bull’s eye rash [ 11 , 23 , 24 , 25 ]. Some studies demonstrated that patients with TBIs may have delayed or no seroconversion [ 22 , 26 , 27 , 28 , 29 , 30 , 31 ]. Those with immune deficiencies may also have false negative serology results [ 32 ].…”

Aseptic Meningitis Linked to Borrelia afzelii Seroconversion in Northeastern Greece: An Emerging Infectious Disease Contested in the Region

“…Although serology remains the mainstay of diagnosis, of seronegative Lyme disease has been reported. Moreover, persistent disease has been observed, despite prompt antibiotic treatment in patients who have become seronegative in response to treatment [ 38 , 39 ].…”

Large-Scale Sequencing of Borreliaceae for the Construction of Pan-Genomic-Based Diagnostics

“…Serologic Lb diagnostics are further complicated by variation in the human adaptive immune response. If patients are diagnosed with Lb based on an EM rash and antibiotic treatment is promptly initiated, they might not seroconvert [ 181 , 182 ]. This fact further complicates the surveillance and confirmation of Lb.…”