Neuroborreliosis in an immunosuppressed patient

Neuroborreliosis is a rare but significant manifestation of Lyme disease, particularly in immunosuppressed individuals. We present the case of a 43-year-old patient with a history of follicular lymphoma in remission, currently undergoing maintenance therapy with Rituximab, who presented with progressive neurological symptoms including peripheral facial paralysis, headache, tremors, and lower back pain. Initial cerebrospinal fluid (CSF) analysis showed lymphocytic pleocytosis, but serological and PCR tests for Borrelia burgdorferi were negative. Given the epidemiological context and clinical presentation, a probable diagnosis of neuroborreliosis was made, with the seronegative results attributed to immunosuppression. The patient responded well to intravenous ceftriaxone with significant clinical improvement. This case highlights the diagnostic challenges of neuroborreliosis in immunosuppressed patients and emphasizes the importance of clinical judgment in the absence of confirmatory laboratory findings.