Pôster:

The BYD is a chronic infectious disease, hard to diagnose, caused by Borrelia burgdoferi, with neurological, osteoarticular and cutaneous manifestations. Borrelia burgdoferi is an intracellular bacterium similar to American borreliosis, which is challenging to treat with antibiotics. The disease often has a neurological picture, being more common the involvement of cranial pairs and peripheral neuropathies. In the case below, there was chorea associated with diffuse myalgia, with difficult treatment, even using the protocol for the treatment of neurological manifestations in Brazilian Lyme disease. There is no definitive algorithm on the use of immunoglobulin in these patients, in this case report, there was a good response to the treatment.

Case report

NIA, woman, 42 years old, married, born and from São Paulo, lawyer, with no comorbidities. She was referred to the rheumatology outpatient clinic due to diffuse myalgia for 6 months, intermittent fever, migratory arthritis and tremor in the right hand . On the physical examination, the patient was NAD, no fever, eupneic, hydrated, clearheaded. BP: 120/80mmHg, HR: 92bpm, RRR, no murmurs. Lungs clean of auscultation. Abdomen with no alterations, absence of edema. Arthritis in the wrists, proximal interphalangeal and knees, and chorea in the right hand. EVA index: 8, tender points in 5 locations. Anemia; Ur: 42mg / dl; Cr: 0.8mg / dl; AST: 42U / L; ALT: 43U / L; Serologies for Hepatitis B, C, HIV, parvovirus B19 and Epsteein BAAR: negative. Serology for Lyme Disease (ELISA) IgG and IgM +, Western Blot +, FAN and rheumatoid factor negative; HLA B27 non-reactive; PCR: 92mg / dl; VHS: 42mm / hr. MR of the skull showing demyelination in the prefrontal cortex; normal electroencephalogram (ENMG), chest and hands X-ray unaltered. Administered Ceftriaxone 2g/day for 30 days, Gabapentin, Naltraxone and hydroxychloroquine. Patient returned after 75 days with partial improvement of the symptons, with EVA index of 6 and with no arthritis, but still with myalgia and chorea, being prescribed immunoglobulin. After 2 months, returned with a significant regression of myalgia, EVA of 2, disappearance of tender points and fever.

Conclusion

Continuing medical education on BYD is required due to it is poorly remembered diagnosis and great morbidity with the neurological manifestations that involve cranial nerves. The ENMG does not exclude the involvement of fine fibers and there are reports of good response with immunoglobulin, as in the case above.