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First report of Lyme neuroborreliosis in a returned Australian traveller

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Lyme borreliosis is a tick-borne zoonosis endemic in many parts of the world. We report the first case of Lyme neuroborreliosis in an Australian traveller returning from an endemic area. The diagnosis should be considered in patients with chronic meningoencephalitis and a history of travel to an endemic area.

Clinical record

A 58-year-old woman of European ancestry presented to a rural hospital in New South Wales in May 2014 with an 8-month history of worsening motor instability, confusion and bilateral occipital headaches associated with photophobia, lethargy and somnolence. The patient was from Geraldton in Western Australia and was staying for 2 weeks with her family in NSW. Her symptoms had started 1 month after returning from Lithuania, where she had spent 3 weeks. A tick had bitten her in the pubic hairline during a trip to a pine forest 30 km from Vilnius. One month later, the patient developed two circular non-pruritic rashes on her right thigh (distal to the site of the tick bite) and lower leg, each about 30 mm in diameter; they resolved after 2 weeks without specific intervention. She had experienced continuing headaches, lethargy and a self-limiting episode of diplopia that prompted her to see her general practitioner. Computerised tomography and magnetic resonance imaging of the brain performed before she presented to the hospital showed nothing abnormal.

The patient’s past medical history included…