A 60-Year-Old Swiss Woman Presenting with Migratory Radicular Pain Diagnosed with Lyme Disease by Western Blot

Abstract

BACKGROUND Many diagnostic guidelines have been established to support the diagnosis of Lyme disease, but a recent meta-analysis did not find that 2-tier tests were better than individual tests. Here, we present the case of a patient who was diagnosed by immunoblot only, a second-line test that is usually not performed if the first-line test is negative. CASE REPORT A 60-year-old Swiss woman, without relevant comorbidities, presented to our clinic with 1-week symptoms of migratory radiculitis in the L1, L2, and L5-S1 right dermatomes. Blood analysis and lumbar and brain MRI did not show any significant abnormalities. However, unexpected results were obtained after testing Lyme serologies. They were performed first with LIAISON® test (Diasorin, Italy) then with Borrelia VIRAstripe® immunoblot (Viramed, Germany) and a positive IgM result was only obtained with the latter. Consequently, doxycycline 100 mg 2×/day was initiated and the symptoms completely resolved after 6 weeks of treatment. Ever since, and more than 1 year after the initial presentation, the patient remains symptom-free. CONCLUSIONS As shown, it was possible to diagnose this patient and treat her successfully by testing all the available serologies. Furthermore, we were surprised to find out after a review of the literature that the IgM sensitivity in neuroborreliosis with the LIAISON® test is only 43.9-46% versus 90-100% with VIRAstripe®. Hence, clinicians need to understand the pitfalls of these tests before excluding Lyme disease.