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Disseminated Marginal Zone Lymphoma in a Patient with Lyme Neuroborreliosis: A Case Report.

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Title: Disseminated Marginal Zone Lymphoma in a Patient with Lyme Neuroborreliosis: A Case Report.
Authors: Weisbjerg, Dorit Kraft1,2 (AUTHOR) doritweisbjerg@hotmail.com, Skarphedinsson, Sigurdur1,2 (AUTHOR), Andersen, Nanna Skaarup1,3 (AUTHOR), Kristensen, Louise4 (AUTHOR), Larsen, Thomas Stauffer5 (AUTHOR), Knudtzen, Fredrikke Christie1,2 (AUTHOR)
Source: Case Reports in Oncology. Jan2025, Vol. 18 Issue 1, p213-219. 7p. 2 Illustrations.
Subject Terms: *LYME disease, *LYME neuroborreliosis, *MUCOSA-associated lymphoid tissue lymphoma, *B cells, BONE marrow examination
Abstract: Introduction: Lyme borreliosis has been associated with lymphoma, particularly cutaneous lymphomas. The literature is conflicted regarding the effect of antibiotic therapy in cutaneous marginal zone lymphomas (MZLs) in individuals with Lyme borreliosis. We present a patient diagnosed with Lyme neuroborreliosis (LNB) and disseminated MZL. Case Presentation: A 67-year-old man was seen due to 6 weeks of neuropathic pain with nightly worsening, headache, and 5 kg weight loss. Two weeks prior to symptom debut, he had a tick bite in the left groin, no subsequent rash. A lumbar puncture revealed mononuclear pleocytosis and elevated CSF protein. The patient was admitted and started on ceftriaxone. The Borrelia burgdorferi intrathecal test showed intrathecally produced Borrelia antibodies, and treatment was changed to doxycycline with a total treatment duration of 21 days. A PET/CT revealed enlarged lymph nodes with increased FDG uptake. On pathological examination, the CSF showed 62% clonal B cells – compatible with low-grade B-cell lymphoma. Examination of bone marrow and an inguinal lymph node confirmed disseminated MZL. A control lumbar puncture 8 weeks later showed declining pleocytosis and clonal B cells. At last follow-up 20 months later, he was still asymptomatic and had not required antineoplastic treatment. Conclusion: To our knowledge, this is the first published case of LNB with non-cutaneous B-cell lymphoma treated and remitting on antibiotics alone. Antibiotic treatment for Borrelia-positive lymphomas has yet to be investigated with high-evidence study designs, so clinicians are encouraged to publish both positive and negative findings relevant to this. We believe this case brings new perspectives to future diagnosis and treatment of lymphomas in patients with verified Lyme borreliosis. Introduction: Lyme borreliosis has been associated with lymphoma, particularly cutaneous lymphomas. The literature is conflicted regarding the effect of antibiotic therapy in cutaneous marginal zone lymphomas (MZLs) in individuals with Lyme borreliosis. We present a patient diagnosed with Lyme neuroborreliosis (LNB) and disseminated MZL. Case Presentation: A 67-year-old man was seen due to 6 weeks of neuropathic pain with nightly worsening, headache, and 5 kg weight loss. Two weeks prior to symptom debut, he had a tick bite in the left groin, no subsequent rash. A lumbar puncture revealed mononuclear pleocytosis and elevated CSF protein. The patient was admitted and started on ceftriaxone. The Borrelia burgdorferi intrathecal test showed intrathecally produced Borrelia antibodies, and treatment was changed to doxycycline with a total treatment duration of 21 days. A PET/CT revealed enlarged lymph nodes with increased FDG uptake. On pathological examination, the CSF showed 62% clonal B cells – compatible with low-grade B-cell lymphoma. Examination of bone marrow and an inguinal lymph node confirmed disseminated MZL. A control lumbar puncture 8 weeks later showed declining pleocytosis and clonal B cells. At last follow-up 20 months later, he was still asymptomatic and had not required antineoplastic treatment. Conclusion: To our knowledge, this is the first published case of LNB with non-cutaneous B-cell lymphoma treated and remitting on antibiotics alone. Antibiotic treatment for Borrelia-positive lymphomas has yet to be investigated with high-evidence study designs, so clinicians are encouraged to publish both positive and negative findings relevant to this. We believe this case brings new perspectives to future diagnosis and treatment of lymphomas in patients with verified Lyme borreliosis. Introduction: Lyme borreliosis has been associated with lymphoma, particularly cutaneous lymphomas. The literature is conflicted regarding the effect of antibiotic therapy in cutaneous marginal zone lymphomas (MZLs) in individuals with Lyme borreliosis. We present a patient diagnosed with Lyme neuroborreliosis (LNB) and disseminated MZL. Case Presentation: A 67-year-old man was seen due to 6 weeks of neuropathic pain with nightly worsening, headache, and 5 kg weight loss. Two weeks prior to symptom debut, he had a tick bite in the left groin, no subsequent rash. A lumbar puncture revealed mononuclear pleocytosis and elevated CSF protein. The patient was admitted and started on ceftriaxone. The Borrelia burgdorferi intrathecal test showed intrathecally produced Borrelia antibodies, and treatment was changed to doxycycline with a total treatment duration of 21 days. A PET/CT revealed enlarged lymph nodes with increased FDG uptake. On pathological examination, the CSF showed 62% clonal B cells – compatible with low-grade B-cell lymphoma. Examination of bone marrow and an inguinal lymph node confirmed disseminated MZL. A control lumbar puncture 8 weeks later showed declining pleocytosis and clonal B cells. At last follow-up 20 months later, he was still asymptomatic and had not required antineoplastic treatment. Conclusion: To our knowledge, this is the first published case of LNB with non-cutaneous B-cell lymphoma treated and remitting on antibiotics alone. Antibiotic treatment for Borrelia-positive lymphomas has yet to be investigated with high-evidence study designs, so clinicians are encouraged to publish both positive and negative findings relevant to this. We believe this case brings new perspectives to future diagnosis and treatment of lymphomas in patients with verified Lyme borreliosis. [ABSTRACT FROM AUTHOR]
Copyright of Case Reports in Oncology is the property of Karger AG and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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Items – Name: Title
  Label: Title
  Group: Ti
  Data: Disseminated Marginal Zone Lymphoma in a Patient with Lyme Neuroborreliosis: A Case Report.
– Name: Author
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  Data: <searchLink fieldCode="AR" term="%22Weisbjerg%2C+Dorit+Kraft%22">Weisbjerg, Dorit Kraft</searchLink><relatesTo>1,2</relatesTo> (AUTHOR)<i> doritweisbjerg@hotmail.com</i><br /><searchLink fieldCode="AR" term="%22Skarphedinsson%2C+Sigurdur%22">Skarphedinsson, Sigurdur</searchLink><relatesTo>1,2</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Andersen%2C+Nanna+Skaarup%22">Andersen, Nanna Skaarup</searchLink><relatesTo>1,3</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Kristensen%2C+Louise%22">Kristensen, Louise</searchLink><relatesTo>4</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Larsen%2C+Thomas+Stauffer%22">Larsen, Thomas Stauffer</searchLink><relatesTo>5</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Knudtzen%2C+Fredrikke+Christie%22">Knudtzen, Fredrikke Christie</searchLink><relatesTo>1,2</relatesTo> (AUTHOR)
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  Data: <searchLink fieldCode="JN" term="%22Case+Reports+in+Oncology%22">Case Reports in Oncology</searchLink>. Jan2025, Vol. 18 Issue 1, p213-219. 7p. 2 Illustrations.
– Name: Subject
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  Group: Su
  Data: *<searchLink fieldCode="DE" term="%22LYME+disease%22">LYME disease</searchLink><br />*<searchLink fieldCode="DE" term="%22LYME+neuroborreliosis%22">LYME neuroborreliosis</searchLink><br />*<searchLink fieldCode="DE" term="%22MUCOSA-associated+lymphoid+tissue+lymphoma%22">MUCOSA-associated lymphoid tissue lymphoma</searchLink><br />*<searchLink fieldCode="DE" term="%22B+cells%22">B cells</searchLink><br /><searchLink fieldCode="DE" term="%22BONE+marrow+examination%22">BONE marrow examination</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: <bold><italic>Introduction:</italic></bold> Lyme borreliosis has been associated with lymphoma, particularly cutaneous lymphomas. The literature is conflicted regarding the effect of antibiotic therapy in cutaneous marginal zone lymphomas (MZLs) in individuals with Lyme borreliosis. We present a patient diagnosed with Lyme neuroborreliosis (LNB) and disseminated MZL. <bold><italic>Case Presentation:</italic></bold> A 67-year-old man was seen due to 6 weeks of neuropathic pain with nightly worsening, headache, and 5 kg weight loss. Two weeks prior to symptom debut, he had a tick bite in the left groin, no subsequent rash. A lumbar puncture revealed mononuclear pleocytosis and elevated CSF protein. The patient was admitted and started on ceftriaxone. The <italic>Borrelia burgdorferi</italic> intrathecal test showed intrathecally produced <italic>Borrelia</italic> antibodies, and treatment was changed to doxycycline with a total treatment duration of 21 days. A PET/CT revealed enlarged lymph nodes with increased FDG uptake. On pathological examination, the CSF showed 62% clonal B cells – compatible with low-grade B-cell lymphoma. Examination of bone marrow and an inguinal lymph node confirmed disseminated MZL. A control lumbar puncture 8 weeks later showed declining pleocytosis and clonal B cells. At last follow-up 20 months later, he was still asymptomatic and had not required antineoplastic treatment. <bold><italic>Conclusion:</italic></bold> To our knowledge, this is the first published case of LNB with non-cutaneous B-cell lymphoma treated and remitting on antibiotics alone. Antibiotic treatment for <italic>Borrelia</italic>-positive lymphomas has yet to be investigated with high-evidence study designs, so clinicians are encouraged to publish both positive and negative findings relevant to this. We believe this case brings new perspectives to future diagnosis and treatment of lymphomas in patients with verified Lyme borreliosis. <bold><italic>Introduction:</italic></bold> Lyme borreliosis has been associated with lymphoma, particularly cutaneous lymphomas. The literature is conflicted regarding the effect of antibiotic therapy in cutaneous marginal zone lymphomas (MZLs) in individuals with Lyme borreliosis. We present a patient diagnosed with Lyme neuroborreliosis (LNB) and disseminated MZL. <bold><italic>Case Presentation:</italic></bold> A 67-year-old man was seen due to 6 weeks of neuropathic pain with nightly worsening, headache, and 5 kg weight loss. Two weeks prior to symptom debut, he had a tick bite in the left groin, no subsequent rash. A lumbar puncture revealed mononuclear pleocytosis and elevated CSF protein. The patient was admitted and started on ceftriaxone. The <italic>Borrelia burgdorferi</italic> intrathecal test showed intrathecally produced <italic>Borrelia</italic> antibodies, and treatment was changed to doxycycline with a total treatment duration of 21 days. A PET/CT revealed enlarged lymph nodes with increased FDG uptake. On pathological examination, the CSF showed 62% clonal B cells – compatible with low-grade B-cell lymphoma. Examination of bone marrow and an inguinal lymph node confirmed disseminated MZL. A control lumbar puncture 8 weeks later showed declining pleocytosis and clonal B cells. At last follow-up 20 months later, he was still asymptomatic and had not required antineoplastic treatment. <bold><italic>Conclusion:</italic></bold> To our knowledge, this is the first published case of LNB with non-cutaneous B-cell lymphoma treated and remitting on antibiotics alone. Antibiotic treatment for <italic>Borrelia</italic>-positive lymphomas has yet to be investigated with high-evidence study designs, so clinicians are encouraged to publish both positive and negative findings relevant to this. We believe this case brings new perspectives to future diagnosis and treatment of lymphomas in patients with verified Lyme borreliosis. <bold><italic>Introduction:</italic></bold> Lyme borreliosis has been associated with lymphoma, particularly cutaneous lymphomas. The literature is conflicted regarding the effect of antibiotic therapy in cutaneous marginal zone lymphomas (MZLs) in individuals with Lyme borreliosis. We present a patient diagnosed with Lyme neuroborreliosis (LNB) and disseminated MZL. <bold><italic>Case Presentation:</italic></bold> A 67-year-old man was seen due to 6 weeks of neuropathic pain with nightly worsening, headache, and 5 kg weight loss. Two weeks prior to symptom debut, he had a tick bite in the left groin, no subsequent rash. A lumbar puncture revealed mononuclear pleocytosis and elevated CSF protein. The patient was admitted and started on ceftriaxone. The <italic>Borrelia burgdorferi</italic> intrathecal test showed intrathecally produced <italic>Borrelia</italic> antibodies, and treatment was changed to doxycycline with a total treatment duration of 21 days. A PET/CT revealed enlarged lymph nodes with increased FDG uptake. On pathological examination, the CSF showed 62% clonal B cells – compatible with low-grade B-cell lymphoma. Examination of bone marrow and an inguinal lymph node confirmed disseminated MZL. A control lumbar puncture 8 weeks later showed declining pleocytosis and clonal B cells. At last follow-up 20 months later, he was still asymptomatic and had not required antineoplastic treatment. <bold><italic>Conclusion:</italic></bold> To our knowledge, this is the first published case of LNB with non-cutaneous B-cell lymphoma treated and remitting on antibiotics alone. Antibiotic treatment for <italic>Borrelia</italic>-positive lymphomas has yet to be investigated with high-evidence study designs, so clinicians are encouraged to publish both positive and negative findings relevant to this. We believe this case brings new perspectives to future diagnosis and treatment of lymphomas in patients with verified Lyme borreliosis. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
  Label:
  Group: Ab
  Data: <i>Copyright of Case Reports in Oncology is the property of Karger AG and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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              Text: Jan2025
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