Borrelia burgdorferi myositis: report of eight patients.

 J Neurol. 1993 May;240,5:278-83. Borrelia burgdorferi myositis: report of eight patients. 
Reimers CD, de Koning J, Neubert U, Preac-Mursic V, Koster JG, Müller-Felber W, Pongratz DE, 
Duray PH.
Friedrich-Baur-Institute, Clinic for Internal Medicine Innenstadt, Munich, Germany.
Myositis is a rare manifestation of Lyme disease of unknown pathogenesis. This study describes 
the course of disease in eight patients with Lyme disease, aged 37-70 years, all of whom were 
suffering from histologically proven myositis. The clinical, electrophysiological, and 
myopathological findings are reported. One patient showed signs and symptoms of myositis of all 
limbs. In six patients myositis was localized in the vicinity of skin lesions, arthritis or 
neuropathy caused by Borrelia burgdorferi. In another patient suffering from pronounced 
muscle weakness of the legs and cardiac arrest, inflammation of the myocardium, the conducting 
system and skeletal muscles was revealed at autopsy. Muscle biopsy revealed 
lymphoplasmocellular infiltrates combined with few fibre degenerations in three patients. The 
lymphoplasmocellular infiltrates were found predominantly in the vicinity of small vessels. 
Several spirochetes were stained in six of seven muscle biopsy samples by means of the 
immunogold-silver technique. Culturing of20B. Burgdorferi from the muscle biopsy samples 
was, however, unsuccessful. Antibiotic treatment succeeded in curing the myositis in four of 
six patients. In one patients signs and symptoms improved. One patient died from cardiac arrest 
caused by myocarditis and Guillain-Barré syndrome. The outcome is unknown in one patient. 
Clinical and myopathological findings indicate that Lyme myositis can be caused either by local 
spreading of B. burgdorferi or an unknown antigen or toxin from adjacent tissues or 

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