A 9-year-old previously healthy boy presented with high-grade intermittent fever, severe headache associated with neck stiffness for 5 days, rash over trunk and extremities for 4 days, vomiting for 3 days and diplopia for 2 days. There was no history of seizures, abnormal body movements, altered sensorium or focal deficits. On examination, he had maculopapular erythematous rashes over the trunk and extremities and erythema multiforme. He had bilateral abducens nerve palsy and the rest of the cranial nerve, sensory and motor examination was normal. He had neck stiffness and positive Kernig’s sign. Fundus examination showed grade 4 papilledema. Cerebrospinal fluid workup revealed elevated opening pressure, lymphocytic pleocytosis, normal protein and glucose levels. Neuroimaging showed features suggestive of intracranial hypertension. Borrelia IgM and IgG antibodies came positive. The uniqueness of our case lies with two rare presenting manifestations of Lyme neuroborreliosis in the same child.

中文翻译：

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伴有颅内高压和多形红斑的莱姆神经疏螺旋体病：罕见的表现

一名 9 岁男孩，既往健康，表现为间歇性高烧，严重头痛伴颈部僵硬 5 天，躯干和四肢皮疹 4 天，呕吐 3 天，复视 2 天。没有癫痫发作、异常身体运动、感觉改变或局灶性缺陷病史。查体时，他的躯干和四肢有斑丘疹性红斑和多形性红斑。他有双侧外展神经麻痹，其余颅神经、感觉和运动检查正常。他颈部僵硬，Kernig 征阳性。眼底检查显示 4 级视乳头水肿。脑脊液检查显示开放压力升高、淋巴细胞增多、蛋白质和葡萄糖水平正常。神经影像学显示提示颅内高压的特征。疏螺旋体 IgM 和 IgG 抗体呈阳性。我们案例的独特之处在于同一个孩子有两种罕见的莱姆神经疏螺旋体病表现。