Mystinen leukasärky, kaksoiskuvat ja hajoavat punasolut

Mysterious chin ache, double vision and shattering red blood cells A previously independent, nearly 80-year-old patient came to the university hospital emergency room because of recently appeared double vision, facial pain and vertigo. The computed tomography and -angiography of the head showed no abnormality. A clinical diagnosis of trochlear nerve palsy due to a microinfarction was established. Her condition became soon worse: she had constant pain in the right side of her face. She visited two dentists and an ear, nose and throat specialist twice, but the examinations showed no abnormality. Eventually she fell because of vertigo and was examined again at the emergency room. Thereafter, she was referred for further examination to the geriatric outpatient clinic, where a pericardial effusion was found in the echocardiogram. She was admitted to the city hospital medical ward. Six years earlier, she had been diagnosed with mixed AIHA, which had been symptomless since then, but now the anemia and hemolysis had emerged again. The patient had fever up to 38°C, but C-reactive protein was low (textless1 mg/l). She was tested for several possible infections that could have triggered AIHA and the pericardial effusion. These examinations finally led to the source of these complex symptoms, as both IgG and IgM antibodies against Borrelia were elevated in the serum. A cerebrospinal fluid sample was taken, and it confirmed the diagnosis of neuroborreliosis, as there was pleocytosis (leucocytes 80×106/l), intrathecal antibodies against Borrelia and an elevated level of chemokine (C-X-C motif) ligand 13 (CXCL13) in the cerebrospinal fluid. The patient was treated with oral doxicyclin 100 mg twice daily for 4 weeks, and all her symptoms as well as the pericardial effusion disappeared during or soon after this treatment.