QJM: An International Journal of Medicine, 2015, 755–756 doi: 10.1093/qjmed/hcv043 Advance Access Publication Date: 6 February 2015 Correspondence
CORRESPONDENCE
On the radar: Lyme neuroborreliosis, an infectious cause of cerebral vasculitis S. Pearson Address correspondence to S. Pearson, Lyme Disease Action, PO Box 235, Penryn, Cornwall, TR10 8WZ. email: [email protected]
References 1. Spath NB, Amft N, Farquhar D. Cerebral vasculitis in rheumatoid arthritis. Q J Med 2014; 107:1027–9.
2. Back T, Gru¨nig S, Winter Y, Bodechtel U, Guthke K, Khati D, et al. Neuroborreliosis-associated cerebral vasculitis: longterm outcome and health-related quality of life. J Neurol 2013; 260:1569–75. 3. Public Health England. Lyme borreliosis, epidemiology and surveillance. 2013. https://www.gov.uk/government/ publications/lyme-borreliosis-epidemiology/lyme-borreliosisepidemiology-and-surveillance (13 February 2015, date last accessed). 4. Health Protection Scotland. Lyme disease, Scotland Annual Totals. 2014. http://www.documents.hps.scot.nhs..uk/giz/10year-tables/lyme.pdf (13 February 2015, date last accessed). 5. Evans R, Mavin S, Holden S, Munro A, Gunn G. Lack of accurate information on the prevalence of Lyme disease in the UK. BMJ 2014; 348:2037. 6. Public Health England. Recent epidemiology of infectious syphilis and congenital syphilis. Health Protection Report 2013; 7. https://www.gov.uk/government/uploads/system/uploads/ attachment_data/file/336760/hpr4413_sphls.pdf (13 February 2015, date last accessed). 7. Health Protection Scotland. Syphilis in Scotland 2012: update. Published 26 June 2013. http://www.hps.scot.nhs.uk/ bbvsti/wrdetail.aspx?id=55318&wrtype=6 (13 February 2015, date last accessed). 8. Public Health England. National HIV surveillance data tables. 2013. https://www.gov.uk/government/statistics/hivdata-tables (13 February 2015, date last accessed).
C The Author 2015. Published by Oxford University Press on behalf of the Association of Physicians. V
All rights reserved. For Permissions, please email: [email protected]
755
Downloaded from by guest on October 25, 2015
Dear Sir Spath et al. describe a case report of a 52 year old woman with rheumatoid arthritis and cerebral vasculitis where possible infectious causes, including syphilis and HIV, were excluded prior to commencing immunosuppressant therapy.1 We suggest that it is advisable to consider Lyme neuroborreliosis in the differential diagnosis since it is known to cause cerebral vasculitis.2 Lyme disease is endemic throughout the UK and the number of laboratory confirmed cases has steadily risen to just over 1000 in 2011,3,4 which is thought to significantly underestimate the true incidence.5 Males and females are equally affected with the highest rate being among those aged between 45 and 64 years.3 In this particular case, Lyme neuroborreliosis would be more likely than syphilis and therefore worthy of investigation. The incidence of syphilis for women in England has fallen significantly to 265 cases in 2012 with women over 50 years being least likely to receive this diagnosis.6 Scotland recorded only 17 cases of syphilis in females in 2012.7 Public Health England data tables for HIV record only 220 cases in women over 50 years in 2012.8 We are not proposing Lyme neuroborreliosis as the diagnosis in this case but seek to raise awareness amongst physicians to keep this possibility in mind when investigating an infectious aetiology for cerebral vasculitis.
CORRESPONDENCE
On the radar: Lyme neuroborreliosis, an infectious cause of cerebral vasculitis S. Pearson Address correspondence to S. Pearson, Lyme Disease Action, PO Box 235, Penryn, Cornwall, TR10 8WZ. email: [email protected]
References 1. Spath NB, Amft N, Farquhar D. Cerebral vasculitis in rheumatoid arthritis. Q J Med 2014; 107:1027–9.
2. Back T, Gru¨nig S, Winter Y, Bodechtel U, Guthke K, Khati D, et al. Neuroborreliosis-associated cerebral vasculitis: longterm outcome and health-related quality of life. J Neurol 2013; 260:1569–75. 3. Public Health England. Lyme borreliosis, epidemiology and surveillance. 2013. https://www.gov.uk/government/ publications/lyme-borreliosis-epidemiology/lyme-borreliosisepidemiology-and-surveillance (13 February 2015, date last accessed). 4. Health Protection Scotland. Lyme disease, Scotland Annual Totals. 2014. http://www.documents.hps.scot.nhs..uk/giz/10year-tables/lyme.pdf (13 February 2015, date last accessed). 5. Evans R, Mavin S, Holden S, Munro A, Gunn G. Lack of accurate information on the prevalence of Lyme disease in the UK. BMJ 2014; 348:2037. 6. Public Health England. Recent epidemiology of infectious syphilis and congenital syphilis. Health Protection Report 2013; 7. https://www.gov.uk/government/uploads/system/uploads/ attachment_data/file/336760/hpr4413_sphls.pdf (13 February 2015, date last accessed). 7. Health Protection Scotland. Syphilis in Scotland 2012: update. Published 26 June 2013. http://www.hps.scot.nhs.uk/ bbvsti/wrdetail.aspx?id=55318&wrtype=6 (13 February 2015, date last accessed). 8. Public Health England. National HIV surveillance data tables. 2013. https://www.gov.uk/government/statistics/hivdata-tables (13 February 2015, date last accessed).
C The Author 2015. Published by Oxford University Press on behalf of the Association of Physicians. V
All rights reserved. For Permissions, please email: [email protected]
755
Downloaded from by guest on October 25, 2015
Dear Sir Spath et al. describe a case report of a 52 year old woman with rheumatoid arthritis and cerebral vasculitis where possible infectious causes, including syphilis and HIV, were excluded prior to commencing immunosuppressant therapy.1 We suggest that it is advisable to consider Lyme neuroborreliosis in the differential diagnosis since it is known to cause cerebral vasculitis.2 Lyme disease is endemic throughout the UK and the number of laboratory confirmed cases has steadily risen to just over 1000 in 2011,3,4 which is thought to significantly underestimate the true incidence.5 Males and females are equally affected with the highest rate being among those aged between 45 and 64 years.3 In this particular case, Lyme neuroborreliosis would be more likely than syphilis and therefore worthy of investigation. The incidence of syphilis for women in England has fallen significantly to 265 cases in 2012 with women over 50 years being least likely to receive this diagnosis.6 Scotland recorded only 17 cases of syphilis in females in 2012.7 Public Health England data tables for HIV record only 220 cases in women over 50 years in 2012.8 We are not proposing Lyme neuroborreliosis as the diagnosis in this case but seek to raise awareness amongst physicians to keep this possibility in mind when investigating an infectious aetiology for cerebral vasculitis.
