Myositis caused by Borrelia burgdorferi: Report of four cases

Reimers, Carl D.; Pongratz, D.; Neubert, U.; Pilz, Andrea; Hübner, Gerhard; Naegele, Matthias; Wilske, Bettina; Duray, Paul H.; Koning, J. de

doi:10.1016/0022-510x(89)90089-0

Cited by 40 publications

(19 citation statements)

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“…Gallium-67 scans have shown intense skeletal muscle uptake in some cases (2,32). Antibiotic treatment is usually but not always effective (48). Rarely, necrotizing myopathy has been reported (52).…”

Section: Discussionmentioning

confidence: 99%

“…Fiber degeneration and increased expression of major histocompatibility complex class I but not of major histocompatibility complex class II have been reported (35). Attempts to culture spirochetes from muscle biopsy specimens have been unsuccessful (48), but silver staining has revealed the presence of spirochetes (2,17,18). Gallium-67 scans have shown intense skeletal muscle uptake in some cases (2,32).…”

Section: Discussionmentioning

confidence: 99%

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Infection and Inflammation in Skeletal Muscle fromNonhuman Primates Infected with Different Genospecies of theLyme Disease SpirocheteBorreliaburgdorferi

et al. 2003

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Lyme borreliosis is a multisystemic disease caused by various genospecies of the spirochete Borrelia burgdorferi. To investigate muscle involvement in the nonhuman primate (NHP) model of Lyme disease, 16 adult Macaca mulatta animals inoculated with strain N40 of B. burgdorferi sensu strictu by syringe or by tick bite or with strain Pbi of B. burgdorferi genospecies garinii by syringe were studied. Animals were necropsied while immunosuppressed on day 50 (two animals each inoculated with B. burgdorferi N40 by syringe and with B. garinii Pbi by syringe) or on day 90, 40 days after immunosuppression had been discontinued (four animals each inoculated with strain N40 by syringe, with strain N40 by tick bite, and with strain Pbi by syringe). Skeletal muscles removed at necropsy were studied by (i) microscopic examination of hematoxylin-eosinstained sections for inflammation and tissue injury; (ii) immunohistochemical and digital image analyses for antibody and complement deposition and cellular inflammation; (iii) Western blot densitometry for the presence of antibodies; and (iv) reverse transcription-PCR for measurement of the spirochetal load or C1q (the first component of the complement cascade) synthesis. The results showed that N40 was more infectious for NHPs than Pbi. NHPs inoculated with N40 but not with Pbi developed myositis. The inflammation in skeletal muscle was more severe in NHPs inoculated with N40 by syringe than in those inoculated by tick bite. The predominant cells in the inflammatory infiltrate were T cells and plasma cells. The deposition of antibody and complement in inflamed muscles from N40-inoculated NHPs was significantly higher than that in Pbiinoculated NHPs. The spirochetal load was very high in the two N40-inoculated NHPs examined while they were immunosuppressed but decreased to minimal levels in the NHPs when immunocompetence was restored. We conclude that myositis can be a prominent feature of Lyme borreliosis depending on the infecting organism and host immune status.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Infection and Inflammation in Skeletal Muscle fromNonhuman Primates Infected with Different Genospecies of theLyme Disease SpirocheteBorreliaburgdorferi

et al. 2003

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“…Carolina de Souza Müller (1) , Acir Rachid Filho (2) , David Cezar Titton (2) , Eduardo Santos Paiva (2) Departamento …”

Section: Manifestações Clínicas E Laboratoriais De Polimiosite Em Um unclassified

“…(1) , que descreve um quadro de polimiosite na vigência da instalação clínica de doença de Chagas. Reimers et al (2) descreveram quatro casos de miosite causada por Borrelia burgdorferi, sendo a doença de Lyme também a etiologia de doença muscular inflamatória em outro caso mais recente descrito por Horowitz et al (3) . Magid et al (4) relataram a associação de doença muscular inflamatória e infecção na vigência de toxoplasmose aguda.…”

Section: Introductionunclassified

Manifestações clínicas e laboratoriais de polimiosite em um caso de leptospirose

Müller¹,

Filho²,

Titton³

et al. 2006

Rev. Bras. Reumatol.

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rElato dE caso casE rEPort RESUMO Nem sempre é possível estabelecer uma clara distinção entre as doenças musculares de causa infecciosa e as miosites idiopáticas. Há situações, inclusive, em que se considera existir uma relação causal entre ambas as doenças. Descrevemos o caso de uma paciente com manifestações clínicas e laboratoriais de polimiosite que apresentou infecção precedente de leptospirose, em que se considera a hipótese de ação de "gatilho" do agente infeccioso no quadro muscular inflamatório. Palavras INTRODUÇÃOHá na literatura inúmeros relatos de doenças infecciosas atuando como "gatilhos" no desencadeamento da doença muscular inflamatória. Entre os trabalhos brasileiros, destaca-se o de Cossermelli e cols.( 1) , que descreve um quadro de polimiosite na vigência da instalação clínica de doença de Chagas. Reimers et al (2) descreveram quatro casos de miosite causada por Borrelia burgdorferi, sendo a doença de Lyme também a etiologia de doença muscular inflamatória em outro caso mais recente descrito por Horowitz et al (3) . Magid et al (4) relataram a associação de doença muscular inflamatória e infecção na vigência de toxoplasmose aguda. São todos casos de pacientes com miosite idiopática, em que altos títulos de anticorpos contra os agentes infecciosos são detectados, sugerindo que a doença inflamatória possa ser uma conseqüência tardia da infecção por esses agentes.Relatamos o caso clínico de paciente com polimiosite, que teve o quadro clínico exacerbado pela infecção por leptospirose. Inúmeras das complicações clínicas desenvolvidas pela paciente foram decorrentes desta associação inusitada, e foram de difícil discriminação, pois ambas enfermidades apresentam aspectos clínicos comuns. RELATO DE CASOPaciente feminina de 19 anos foi internada por quadro de mialgia, astenia, náuseas e vômitos de evolução há três meses. Havia relato de picos febris e uso de amoxicilina sem resolução dos sintomas. À admissão, apresentava força muscular grau II e dores musculares difusas. A incapacidade de deglutição obrigou a instalação de sonda nasogástrica. Não havia, no entanto, evidências de comprometimento da musculatura respiratória. Exames laboratoriais revelavam CK de 135.000 U/L (normal de 26 até 142 U/L), com transaminases e LDH igualmente elevadas (SGOT = 2.150 U/L, SGPT = 907 U/L e LDH = 4.357U/L, para valores normais de até 40 U/L para ambas as enzimas hepáticas, e ABSTRACT Sometimes, it is not possible to establish an obvious distinction between the muscular manifestations due to infectious diseases and the idiopathic myositis. In fact, in some situations it is believed there is a causal relationship between those diseases. We describe the case of a patient with clinical and laboratorial features of polymyositis who had developed leptospirosis previously. The hypothesis of the infectious agent acting as a "trigger" to the muscular disease is discussed.

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“…His skin changes as well as his muscle symptoms markedly improved, the muscle enzyme levels normalized, and he was discharged on a regimen of 15 mg of prednisolone daily. The prednisolone dosage was tapered off over the following 6 weeks.…”

Section: Case Reportmentioning

confidence: 99%

Lyme disease in a 74‐year‐old forest owner with symptoms of dermatomyositis

Hoffmann

Stichtenoth²,

Zeidler³

et al. 1995

Arthritis & Rheumatism

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We describe a 73-year-old forest owner with widespread erythema, myalgia, and proximal muscle weakness. The clinical signs and the results of electromyography, magnetic resonance imaging, and a muscle biopsy were consistent with dermatomyositis. However, serology was positive for Borreliu burgdorferi. More importantly, B burgdorferi DNA was detected in skin by polymerase chain reaction techniques, and spirochetelike organisms were detected in the muscle by silver staining. Lyme disease with muscle involvement can mimic or trigger dermatomyositis and should be considered in the differential diagnosis of dermatomyositis.Lyme disease is a multisystem organ disease caused by Borreliu burgdorferi. It primarily affects the skin, joints, nervous system, and heart (I). Although this is uncommon, B burgdorferi has been shown to infiltrate into the muscles, causing a special form of myositis, which is usually localized and is often associated with neurologic symptoms (2-1 1).We report the case of a patient with typical features of dermatomyositis, including recurrent rashes and proximal muscle weakness. Examination of skin and muscle biopsy samples, however, showed invasion by B burgdorferi, spirochete-like organisms, and mononuclear cell infiltrates. To our knowledge, this is the first report of a patient with definite Lyme disease that is clinically almost indistinguishable from dermatomyositis. CASE REPORTThe patient, a 73-year-old white man, was admitted to the Hannover Medical School Hospital because of muscle pain and weakness in his shoulders and thighs, as well as erythematous lesions on his face, hands, and forearms. His symptoms had begun 3 months prior to admission, when he consulted a local dermatologist. He was started on methylprednisolone, 16 mg daily. There had been no improvement in his condition, and he was therefore referred to our institution.On admission, the patient was found to have diffuse pruritic erythema with edema of his hands, induration and partial epidermal atrophy of his forearms, and a pale violaceous heliotrope erythema of his face. In addition, there was marked proximal muscle weakness and atrophy in his shoulders and thighs in a symmetric distribution. On direct questioning, he mentioned several tick bites that had occurred over recent years as he was working in his forest. However, he denied having any symptoms of erythema migrans.The patient's creatine kinase (CK) level was 195 unitsfliter (normal <70) with an MB isoenzyme level of 5.6 unitsfliter, aldolase was 4.6 unitdliter (normal <3), serum glutamic oxaloacetic transaminase (SGOT) was 25 unitdliter, lactic dehydrogenase (LDH) was 416 unitsfliter, IgG was 21.4 gmiliter, IgM was 3.9 g d i t e r , and serum electrophoresis showed 26% gamma globulins and 50% albumin. Antinuclear antibodies were positive at a titer of 1:160. Rheumatoid factor, anti-extractable nuclear antigen, anti-DNA, anti-Scl-70, anti-Jo-l , anti-PL7, anti-PL12, anti-Ku-l , anti-Mi-2, and anti-PM1 were negative.Serum antibodies to B burgdorferi, as determined by in...

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Myositis caused by Borrelia burgdorferi: Report of four cases

Cited by 40 publications

References 13 publications

Infection and Inflammation in Skeletal Muscle fromNonhuman Primates Infected with Different Genospecies of theLyme Disease SpirocheteBorreliaburgdorferi

Infection and Inflammation in Skeletal Muscle fromNonhuman Primates Infected with Different Genospecies of theLyme Disease SpirocheteBorreliaburgdorferi

Manifestações clínicas e laboratoriais de polimiosite em um caso de leptospirose

Lyme disease in a 74‐year‐old forest owner with symptoms of dermatomyositis

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