Nystagmus as a Rare Presenting Symptom of Neuroborreliosis in a Child

This case report describes a previously healthy 4-year-old boy with neuroborreliosis who presented with a nystagmus of central origin and a right-sided peripheral facial palsy. Most common presentations in childhood are facial nerve palsy and aseptic meningitis. However, neuroborreliosis can present with nonspecific symptoms. A nystagmus as a presenting symptom of neuroborreliosis has never been described in medical Anglo Saxon literature before. The diagnosis of neuroborreliosis was confirmed by the following three criteria: (1) a lymphocytic pleiocytosis in the cerebrospinal fluid (CSF), (2) positive Borrelia burgdorferi-specific IgG and IgM in the CSF, and (3) an increased CSF to serum B. burgdorferi-specific antibody index, indicating intrathecal antibody production. The diagnostic workup of neuroborreliosis should always include CSF collection. Treatment with intravenous ceftriaxone was started early in the clinical course. Besides a very mild gaze-dependent horizontal pendular nystagmus, there was a complete resolution of symptoms without sequelae.