Motor neuron disease features in a patient with neuroborreliosis and a cervical anterior horn lesion.

A variety of neurological syndromes has been described in neuroborreliosis: cranial nerve palsies, radiculopathy, axonal neuropathy, stroke, parkinsonism, transverse myelitis, supranuclear palsy, Guillain-Barré syndrome, ... We report a case of neuroborreliosis with cervical myelitis presenting clinically as a lower motor neuron syndrome of the upper and lower limbs with proximal and distal pareses and atrophies as well as bulbar dysarthria and dysphagia. During the course of the disease the patient developed the clinical picture of a meningoencephalitis. After initiating ceftriaxone treatment the patient showed a complete recovery. In endemic regions for Lyme disease, in all neurological syndromes neuroborreliosis has to be excluded.

[Fever of unknown origin caused by anaplasmosis]. / Koorts van onbekende oorsprong, met als oorzaak anaplasmose.

A 74-year-old man in good clinical condition presented with complaints of recurrent fever up to 38 degrees C and diffuse thoracic pain, both present for several weeks. Antibiotic therapy did not result in disappearance of the symptoms. Except for a picture of chronic inflammation and a positive Anaplasma IgM antibody titre, serology yielded no indication ofthe diagnosis. Further investigation, including imaging, showed no convincing cause. 'Anaplasma infection' remained the working diagnosis. One month after hospitalisation, the patient was free of fever without any type of therapy. Control blood tests revealed seroconversion to Anaplasma IgG antibodies, constituting serological evidence of a recent infection. The prevalence ofanaplasmosis is increasing. Mice are the principal reservoir for the intracellular bacteria and the infection is transmitted by ticks. In case of fever of unknown origin, since the transmission takes place in the same manner, one should consider both Borrelia and an infection with Anaplasma.