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Neuroborreliosis — SCE Neurology MCQ

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HardCNS infectionsNeuroborreliosisSCE Neurology

A 42-year-old develops painful lymphocytic meningoradiculitis and a unilateral lower-motor-neurone facial palsy 3 weeks after an expanding erythema migrans rash. There is no encephalitis or myelitis, and swallowing is safe. Which treatment is most appropriate?

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Correct answer: D — Oral doxycycline 100 mg twice daily or 200 mg once daily for 21 days

Cranial-nerve palsy and peripheral nervous-system neuroborreliosis can be treated with oral doxycycline 100 mg twice daily or 200 mg once daily for 21 days under NICE guidance. Central nervous-system disease such as encephalitis or myelitis uses a higher doxycycline dose or ceftriaxone regimen; that is explicitly absent here. Five- or seven-day courses are too short. Neurological Lyme disease requires antimicrobial treatment rather than observation as a purely post-infectious phenomenon. Pregnancy, age, contraindications and ability to take oral treatment would modify the choice.

Reference: NICE NG95, Lyme disease: https://www.nice.org.uk/guidance/ng95/chapter/Recommendations