Journal Identification = ABC Article Identification = 1515 Date: September 16, 2013 Time: 1:24 pm
doi:10.1684/abc.2020.1515
108 To cite this article: Lefeuve F, Baseggio L. Lymphoid involvement of cerebrospinal fluid in Lyme disease.Ann Biol Clin2020; 78(1): 108-10 doi:10.1684/abc.2020.1515
Letter
Ann Biol Clin 2020; 78 (1): 108-10
Lymphoid involvement of cerebrospinal fluid in Lyme disease
Neuroborréliose : infiltration lymphoïde pléomorphe du LCR
Floriane Lefeuve Lucile Baseggio
Groupement hospitalier Lyon-Sud, Hospices civils de Lyon, Laboratoire d’hématologie biologique, France
Article received August 22, 2019, accepted December 04, 2019
After typical rash (erythema migrans), neurological involvement is the most common clinical manifestation in Lyme disease. The cerebrospinal fluid (CSF) analysis may help in any diagnostic doubt characterized by CSF pleo- cytosis (lymphoïd and plasma cells) andborrelia-specific antibodies produced intathecally.
A 62-year-old man presented with a back pain radiating to right thigh, severe asthenia and no fever. Serum C pro- tein and erythrocyte sedimentation rate were normal. Two months later given tetraparesis manifestation, a MR scan of spine has been realized and displayed high-density signal extending between T11 to L1. The MR scan of brain was normal. Infectious mononucleosis screen, syphilis, HIV, hepatitis B and C serology were negative. Cerebrospinal fluid (CSF) revealed hypercellular specimen (white blood cells=630/L, red blood cells=10/L). The protein concen- tration was 2.1 g/L and glucose 3.2 mmol/L (normal paired plasma glucose). The cytological analysis of CSF (cyto- centrifuge preparation, magnification x60, May-Grünwald Giemsa staining,figure 1 A-C) showed polymorphous lym- phoïd population including small lymphocytes, granular lymphocytes, large immunoblasts (arrow) and plasma cells
(asterisk). Flow cytometry (FCM) immunophenotyping of CSF (figure 1 D) identified mainly small T-cells (84%) asso- ciated to polytypic B-cells (10%) and polytypic plasma cells (4%). Morphology associatied to immunologic pro- file argue to CSF involvemennt by activated lymphoïd population. The patient only remembered untreated skin lesions on abdomen 10 weeks before. TheBorreliaenzyme immunoassy result was found to be reactive and confirmed with positive immunoblot to IgG and IgM. The CSF also contained antibodies toBorreliaand theBorrelia-specific CSF to serum IgG antibody index was at 8.1 (normal range
<1.3). The patient was therefore diagnosed with Lyme neuroborreliose and treated with intravenous ceftriaxone, which resulted in an almost complete recovery.
In conclusion, this case illustrates CNS involvement in neu- roborreliosis that will develop in less of 5% of untreated erythema migrans, and usually 4-6 weeks after tick expo- sure [1]. Although the analysis of CSF is not recommended in all patients, in any diagnostic doubt it will be use- fulness with characteristically CSF pleocytosis (lymphoïd and plasma cells) and borrelia-specific antibodies produced intathecally [2].
Correspondance :L. Baseggio
<lucile.baseggio@chu-lyon.fr>
Journal Identification = ABC Article Identification = 1515 Date: September 16, 2013 Time: 1:24 pm
Ann Biol Clin, vol. 78, n◦1, janvier-février 2020 109
Neuroborreliosis: lymphoid involvement of cerebrospinal
All Events
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CD45 V500-A FSC-A
CD19 PE Cy1-A
CD19 PE Cy1-A
CD138 PE Cy5-A KAPPA APC-A
CD38 V450 Pacufuc Blue-A LAMBDA FITC-A
CD19 PE Cy1-A CD20+CD4 V450-A
LYMPHO LYMPHO
CD8+KAPPA FITC-A
CD8+KAPPA FITC-A France FlowLST2-modifie-T
(× 1000)
SSC-A(× 1000) 25020015010050
SSC-ACD5 Par CP-Cy5-5-A CD10 APC-A CD8+KAPPA FITC-A
(× 1000) 25020015010050
SSC-A CD56-LAMBDA PE-A
(× 1000)
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CD56-LAMBDA PE-A 1051041030-633-633 -351
-351
-351
-100 0 103 Q3-6
Q2-6 Lymbda 1
LAMBDA CD19+
CD3+
KAPPA Q3
Q2 Kappa 1 64%
57%
14%
PCL+-1 27%
PCL+-1 68%
Plasma cells polytypic
Large B-cells Dim CD19+
polytypic Small B-cells Strong CD19+
Polytypic
82%
30%
T-cells 84%
B-cells 10%
25%
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LYMPHO CD45
CD45 CD45
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Figure 1.Cerebrospinal fluid (CSF) (cytocentrifuge preparation, magnification x60, May-Grünwald Giemsa staining,A-C): small lymphoid cells (scanty cytoplasm and regular nuclear), granular lymphocytes (abundant and pale cytoplasm with azurophilic granules), immunoblasts (large cells with abundant and basophilic cytoplasm; arrow) and plasma cells (eccentric nuclei with clumped chromatin and basophilic cytoplasm; asterisk). Immunophenotype by multiparameter flow cytometry (FCM) was realized on CSF (D). Data were acquired on a BD FACSCanto II cytometer and analyzed with BD FACS DIVA version 8.0.1 software (*Becton Dickinson, San Jose, CA, USA). A first panel of 10 antibodies in one tube was used to identify T- and B-cells : CD3 (clone SK7,15-18*, APC-H7), CD5 (clone L17F12*, PerCP Cy5.5), CD4 (clone RPA-T4*, V450), CD8 (RPA-T8*, FITC), CD45 (clone HI30*, V500), CD20 (clone L27-9*, V450), CD19 (clone J3-119**, PE Cy7), CD10 (clone HI10a3*, APC), CD56 (clone NCAM 16,2*, PE) and kappa/lambda (***, FITC/PE) (** Beckman-Coulter, Hialeah, FL, USA, ***Dako, Carpinteria, CA). A second panel was used to identify plasma cells (including CD38 [clone HB7*, V450], CD138 [Syndecan-1**, PC5]).
Journal Identification = ABC Article Identification = 1515 Date: September 16, 2013 Time: 1:24 pm
110 Ann Biol Clin, vol. 78, n◦1, janvier-février 2020
Letter
Conflict of interest: none of the authors has any conflict of interest to disclose.
Reference
1. Hansen K, Lebech AM. The clinical and epidemiological profile of Lyme neuroborreliosis in Denmark 1985-1990, (1992) A prospective study of 187 patients with Borrelia burgdorferi specific intrathecal antibody production. Brain1992 ; 115 : 399-423.
2. NICE, 2018. Lyme disease overview. https://pathways. nice. org.
uk/pathways/lyme- disease.
