ro13-9904 and Hallucinations

A young woman was examined in the Emergency Department for fever, pharyngitis and widespread petechial rash. Physical examination, including neurological evaluation, did not show any other abnormalities. Chest X-ray was negative. Blood exams showed leukocytosis and CPR 20 mg/dL (nv<0.5 mg/dL). On the basis of these results and petechial rash evidence, lumbar puncture was performed. CSF was opalescent; physico-chemical examination showed: total proteins 2.8 (nv 0.15-0.45), glucose 5 (nv 59-80), WBC 7600/μL (nv 0-4/ μL). In the hypothesis of meningococcal meningitis, antimicrobial therapy was started. Blood and cerebrospinal fluid cultures were positive for N. meningitidis. During the first hours the patient experienced hallucinations and mild psychomotor agitation, making a spontaneous recovery. A brain MRI showed minimal extra-axial inflammatory exudates. She was discharged after 10 days in good condition. We underline the need to consider meningococcal meningitis diagnosis when any suggestive symptom or sign is present, even in the absence of the classic meningitis triad, to obtain earlier diagnosis and an improved prognosis.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Diffusion Magnetic Resonance Imaging; Fever; Hallucinations; Humans; Immunocompetence; Meningitis, Meningococcal; Neisseria meningitidis; Neuroimaging; Pharyngitis; Psychomotor Agitation; Purpura; Spinal Puncture

We describe a 7-year-old boy with Alice in Wonderland syndrome associated with Lyme disease. He presented with metamorphopsia and auditory hallucinations in the absence of previous tick bites or other signs of Lyme disease. The boy never developed clinical seizures, and electroencephalograms during these spells indicated no epileptic activity. There was no history of migraine. Cranial magnetic resonance imaging produced normal results. Lyme serology tested positive in both serum and cerebrospinal fluid. He was treated with intravenous ceftriaxone for 3 weeks, with complete resolution of signs. This case report is the first, to our knowledge, of neuroborreliosis presenting as Alice in Wonderland syndrome with complete resolution of findings after intravenous antibiotic treatment.

Topics: Anti-Bacterial Agents; Borrelia burgdorferi; Ceftriaxone; Child; Hallucinations; Humans; Lyme Neuroborreliosis; Male; Treatment Outcome; Vision Disorders

This is a report of 2 patients with Lyme disease who initially presented with severe constipation, which progressed to ascending muscular weakness resembling acute idiopathic polyneuritis, with neuropsychiatric symptoms, severe urinary retention, and hyponatremia. These symptoms resolved following proper antibiotic therapy.

Topics: Aged; Anti-Bacterial Agents; Antibodies, Bacterial; Ceftriaxone; Constipation; Depression; Hallucinations; Humans; Hyponatremia; Lyme Neuroborreliosis; Male; Mental Disorders; Middle Aged; Muscle Weakness; Serologic Tests; Treatment Outcome; Urination Disorders

Musical hallucinations are poorly understood auditory hallucinations that occur in patients with otologic or neurologic diseases. We report the first cases of musical hallucinations in two patients with neurologic Lyme disease. Both subjects were women with clinical and laboratory evidence of chronic Lyme disease, progressive neurologic dysfunction, and abnormal magnetic resonance imaging of the brain. There was no evidence of hearing loss in either case. Musical hallucinations had a sudden onset and took the form of patriotic or operatic music. The auditory hallucinations disappeared with intravenous (i.v.) antibiotic therapy in both patients, but the hallucinations recurred when i.v. antibiotic therapy was discontinued in one case. Response to therapy was accompanied by an increase in the CD57 lymphocyte subset in one patient, whereas recurrent hallucinations were associated with persistently low CD57 levels in the other case. We conclude that musical hallucinations may be associated with neurologic Lyme disease. These auditory hallucinations appear to respond to i.v. antibiotic therapy. Patients with musical hallucinations of unknown cause should be tested for infection with the Lyme disease spirochete.

Topics: Aged; Borrelia burgdorferi; Brain; Ceftriaxone; Diagnosis, Differential; Disease Progression; Drug Resistance; Drug Therapy, Combination; Female; Follow-Up Studies; Hallucinations; Humans; Lyme Neuroborreliosis; Magnetic Resonance Imaging; Music; Neuropsychological Tests; Polymerase Chain Reaction