Supplementary Material for: Lyme Neuroborreliosis Presenting With Isolated Intracranial Hypertension: A Case Report

Background:
Lyme borreliosis (LB), a tick-borne illness caused by Borrelia burgdorferi, is increasingly prevalent in Nova Scotia (NS), Canada, which has the highest incidence in North America. While most cases present as early localized disease, approximately 20% develop early disseminated disease, which can include neurological symptoms, an entity called Lyme neuroborreliosis (LNB). This case report describes an unusual LNB presentation with isolated intracranial hypertension (IH).
Case Presentation:
A 6-year-old female presented to our pediatric hospital with binocular horizontal diplopia, headache, fever, malaise and suspected papilledema 47 days after an embedded tick bite. A diagnosis of Lyme disease had been made 10 days prior in the community based on positive serologies and erythema migrans, but she developed a Jarisch-Herxheimer reaction within 24h of oral doxycycline, leading to an antibiotic change to amoxicillin. During the hospital admission, an ophthalmological examination revealed papilledema and intracranial hypertension was evidenced by an opening pressure of 36 mmHg and brain MRI findings. The lumbar puncture revealed pleocytosis and positive cerebrospinal fluid antibodies for Borrelia. The patient was initially treated with two days of ceftriaxone, followed by a 12-day outpatient course of doxycycline for LNB. High doses of acetazolamide (500mg TID) were needed to achieve symptom control. Two months after her hospital discharge there was resolution of papilledema and the acetazolamide was weaned.
Conclusion:
This case highlights the importance of considering Lyme disease in the differential diagnosis of IH, particularly in endemic regions. Early recognition, diagnostic workup, and appropriate treatment are crucial for optimal outcomes in LNB.

Background:
莱姆疏螺旋体病（Lyme borreliosis, LB）是由伯氏疏螺旋体（Borrelia burgdorferi）引发的蜱传疾病，在加拿大新斯科舍省（Nova Scotia, NS）的发病率持续攀升，该地区为北美地区莱姆病发病率最高的区域。多数患者表现为早期局限性病变，约20%会进展为早期播散性病变，其中可出现神经系统症状，这类病症被称为莱姆神经疏螺旋体病（Lyme neuroborreliosis, LNB）。本病例报告描述了一例以孤立性颅内高压（intracranial hypertension, IH）为首发表现的罕见LNB病例。
Case Presentation:
一名6岁女性患儿，在被蜱虫叮咬嵌入皮肤47天后，因双眼水平复视、头痛、发热、乏力及疑似视乳头水肿就诊于我院儿科医院。10天前，该患者曾在社区通过血清学检测阳性及游走性红斑（erythema migrans）确诊莱姆病，但在口服多西环素24小时内出现雅里施-赫克斯海默反应（Jarisch-Herxheimer reaction），遂将抗生素更换为阿莫西林。住院期间，眼科检查提示视乳头水肿，颅内压检测显示脑脊液开放压为36mmHg，颅脑MRI结果亦支持颅内高压的诊断。腰椎穿刺结果显示脑脊液白细胞增多，且脑脊液伯氏疏螺旋体抗体呈阳性。患者初始接受2天头孢曲松治疗，随后以12天的门诊多西环素疗程治疗LNB。为有效控制症状，需服用大剂量乙酰唑胺（500mg，每日三次）。出院两个月后，患儿的视乳头水肿消退，乙酰唑胺逐步减量至停用。
Conclusion:
本病例凸显了在颅内高压的鉴别诊断中需考虑莱姆病的重要性，尤其在疾病流行区域。早期识别、规范诊断评估及恰当治疗对于LNB获得最佳预后至关重要。