24 March 2021
: Case report 
“Double Trouble”: Severe Meningoencephalitis Due to Borrelia burgdorferi and Powassan Virus Co-Infection Successfully Treated with Intravenous Immunoglobulin
Unusual or unexpected effect of treatment, Rare coexistence of disease or pathology
Igor Dumic12ABCDEFG*, Bridget Glomski3ABCDEFG, Janki Patel4CD, Terri Nordin23E, Charles W. Nordstrom12EG, Lawrence J. Sprecher12EG, Eric Niendorf5BE, Amteshwar Singh6DEF, Kosana Simeunovic7AF, Anand Subramanian12CD, Oladapo Igandan12EG, Danilo Vitorovic8ACDEFDOI: 10.12659/AJCR.929952
Am J Case Rep 2021; 22:e929952
Table 1. Summary of negative diagnostic tests that were done in our patient to rule out autoimmune, infectious, and paraneoplastic etiologies of encephalitis. Positive tests included: B. burgdorferi serum IgM and IgG, B. burgdorferi PCR in CSF (Mayo Medical Laboratories), and CSF IgM and plaque reduction neutralization test (PRNT) against POWV (CDC, Arboviral Disease Branch, Fort Collins, CO, USA).
| Tests done on serum | Tests done on CSF |
|---|---|
| Ab and PCR Ab and PCR Ab Ab AgQuantiFERON TB GOLDRPRWest nile virus PCRCMV AbEBV AbHIV AbHBV AbHCV AbANARFSSA AbSSB Ab | HSV-1 PCRHSV-2 PCRVZV PCREBV PCRCMV PCREnterovirus PCR PCR 6 PCRAdenovirus PCR PCRSt. Louis Encephalitis IgM and IgG AbCalif (LaCrosse) Encephalitis Virus IgM and IgGWest Equine Encephalitis Virus IgM and IgG AbAnti-ANNA-1 (anti-Hu) AbAnti-ANNA-2 (anti-Ri) AbAnti-ANNA 3 AbAGNA (Sox 1) AbAmphiphysin Ab IgGAnti-PCI-1 Ab (anti-Yo) AbAnti-PCI-Tr AbAnti-PCI-2 AbAntibodies to Ta AbGAD-65 AbAnti-VGKC AbNMO AbAQP-4 Ab |
| Ag – antigen; AGNA – anti-glial/neuronal antibody; Ab – antibody; ANA – anti-nuclear antibody; ANNA – anti-neuronal nuclear antibody; AQP-4 – aquaporin-4; CMV – cytomegalovirus; EBV – Ebstein Barr virus; HBV – hepatitis B virus; HCV – hepatitis C virus; GAD – glutamic acid decarboxylase; HIV – human immunodeficiency virus; HSV – herpes simplex virus; NMO – neuromyelitis optica; PCR –polymerase chain reaction; RPR – rapid plasma regain; RF – Rheumatoid factor; SSA – anti-Sjogren’s syndrome A; SSB – anti-Sjogren’s syndrome B; VZV – Varicella zoster virus; VGKC – voltage gated potassium channel; PCA – Purkinje cell cytoplasmic antibody. | |