Pediatric EMG Cases-Dr. Nguyen Presentation

Dr. Nguyen Presentation

Pdf Summary

In a case presentation by Dr. Gabrielle Nguyen, an 18-year-old female from the Rio Grande Valley experienced a series of puzzling symptoms beginning in February 2023. Initially, she developed a rash and headaches that were treated for a sinus infection. However, her condition progressed to severe pain in her lower back and hip, which was treated with steroids but did not improve. Further symptoms included worsening pain in her extremities, numbness in her hands and feet, and cranial nerve abnormalities, prompting her admission to Texas Children's Hospital at the end of May 2023.<br /><br />A thorough workup at an outside hospital in early May included normal brain and spine MRIs, Lyme disease serologies, and CSF studies, leading to a tentative diagnosis of Lyme disease. Despite starting therapy with IV Rocephin and Doxycycline, the patient's symptoms continued to worsen, including increased mobility issues and severe pain, suggesting involvement beyond Lyme disease.<br /><br />Electrodiagnostic tests revealed severe sensory-motor demyelinating polyneuropathy affecting both upper and lower extremities consistent with a primary demyelinating process such as Guillain-Barré Syndrome (GBS). The case highlights the diagnostic challenge as Neuroborreliosis, a rare manifestation of Lyme disease, can mimic GBS. There are also reports of GBS developing post-Lyme disease treatment due to immune responses.<br /><br />Despite the antibiotic treatment targeting Neuroborreliosis, the progression of her symptoms suggested that primary demyelination consistent with GBS was a more likely underlying cause. This case underlines the need to consider Lyme neuroborreliosis in differential diagnoses when encountering GBS, though the condition is rare and should be primarily considered based on geographical exposure and clinical settings.

Keywords

Gabrielle Nguyen

Rio Grande Valley

Lyme disease

Guillain-Barré Syndrome

Neuroborreliosis

demyelinating polyneuropathy

Texas Children's Hospital

steroids

IV Rocephin

Doxycycline