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Dysuria, Urinary Retention, and Inguinal Pain as Manifestation of Sacral Bannwarth Syndrome.

Finsterer J, Dauth J, Angel K, Markowicz M - Case Rep Med (2015)

Bottom Line: Extensive urological investigations did not reveal a specific cause, which was why neurogenic bladder dysfunction was suspected.Neurologic exam revealed only mildly reduced tendon reflexes.Ceftriaxone may result in progressive recovery of bladder dysfunction and pain.

View Article: PubMed Central - PubMed

Affiliation: Krankenanstalt Rudolfstiftung, Postfach 20, 1180 Vienna, Austria.

ABSTRACT
Only few cases with sacral radiculitis due to infection with Borrelia burgdorferi leading to neurogenic urinary dysfunction have been reported. A 57-year-old male developed urethral pain and urinary retention, requiring permanent catheterization. Extensive urological investigations did not reveal a specific cause, which was why neurogenic bladder dysfunction was suspected. Neurologic exam revealed only mildly reduced tendon reflexes. Cerebral and spinal MRI were noninformative. CSF investigations, however, revealed pleocytosis, elevated protein, and antibodies against Borrelia burgdorferi. Intravenous ceftriaxone for three weeks resulted in immediate improvement of bladder dysfunction, with continuous decline of residual urine volume and continuous increase of spontaneous urine volume even after removal of the catheter and initiation of self-catheterization. Sacral radiculitis due to infection with Borrelia burgdorferi is a potential cause of detrusor areflexia and urethral, perineal, inguinal, and scrotal pain and may be misinterpreted as cystitis or urethritis. Ceftriaxone may result in progressive recovery of bladder dysfunction and pain. Neuroborreliosis may manifest exclusively as neurourological problem.

No MeSH data available.


Related in: MedlinePlus

Course of residual urine volume and spontaneous urine volume after initiation of ceftriaxone during three weeks and during 6 weeks after discontinuation of ceftriaxone; SPC: suprapubic catheter.
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fig1: Course of residual urine volume and spontaneous urine volume after initiation of ceftriaxone during three weeks and during 6 weeks after discontinuation of ceftriaxone; SPC: suprapubic catheter.

Mentions: Since dysuria persisted, and myalgias of the gluteal muscles, cold feet, inguinal, scrotal, and perineal pain had developed after dismissal, he was readmitted 7 days later. The neurologic exam was unchanged compared to the previous exam and lumbar puncture was carried out. CSF investigations revealed mild pleocytosis of 51/3 cells and increased total protein of 84 mg/dL (n, 20–40 mg/dL), which was why an intravenous therapy with ceftriaxone (2 g/d) for three weeks and acyclovir 1500 mg/d was initiated. Since all antibodies against common viruses and PCR for herpes types 1 and 2 and varicella zoster virus were negative in the CSF, the virostatic treatment was discontinued 13 days after initiation. Serum and CSF IgG antibodies against Borrelia were positive by ELISA (Medac Int.), >200 and 116 AU/mL, respectively. Immunoblot (Euroimmun) with serum revealed positive results, most intensively with the antigens VlsE, p39/BmpA, p25/OspC, p19, and p17. The IgG antibody index according to Reiber was 0.9 (n, <1.3). IgG in the CSF was elevated to 4.7 (n, <4.0) and CSF albumin was increased to 65.1 mg/dL (n, 35.0 mg/dL). CSF and blood culture were negative. PCR with CSF for Borrelia was negative. Three days after initiation of ceftriaxone the patient became almost free of pain and started to spontaneously contract the detrusor, to partially void, and to develop a feeling of filling and emptying of the bladder (Figure 1). Only during two days anuria recurred. He developed a normal urine stream and the residual urine volume continuously decreased (Figure 1).


Dysuria, Urinary Retention, and Inguinal Pain as Manifestation of Sacral Bannwarth Syndrome.

Finsterer J, Dauth J, Angel K, Markowicz M - Case Rep Med (2015)

Course of residual urine volume and spontaneous urine volume after initiation of ceftriaxone during three weeks and during 6 weeks after discontinuation of ceftriaxone; SPC: suprapubic catheter.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4664797&req=5

fig1: Course of residual urine volume and spontaneous urine volume after initiation of ceftriaxone during three weeks and during 6 weeks after discontinuation of ceftriaxone; SPC: suprapubic catheter.
Mentions: Since dysuria persisted, and myalgias of the gluteal muscles, cold feet, inguinal, scrotal, and perineal pain had developed after dismissal, he was readmitted 7 days later. The neurologic exam was unchanged compared to the previous exam and lumbar puncture was carried out. CSF investigations revealed mild pleocytosis of 51/3 cells and increased total protein of 84 mg/dL (n, 20–40 mg/dL), which was why an intravenous therapy with ceftriaxone (2 g/d) for three weeks and acyclovir 1500 mg/d was initiated. Since all antibodies against common viruses and PCR for herpes types 1 and 2 and varicella zoster virus were negative in the CSF, the virostatic treatment was discontinued 13 days after initiation. Serum and CSF IgG antibodies against Borrelia were positive by ELISA (Medac Int.), >200 and 116 AU/mL, respectively. Immunoblot (Euroimmun) with serum revealed positive results, most intensively with the antigens VlsE, p39/BmpA, p25/OspC, p19, and p17. The IgG antibody index according to Reiber was 0.9 (n, <1.3). IgG in the CSF was elevated to 4.7 (n, <4.0) and CSF albumin was increased to 65.1 mg/dL (n, 35.0 mg/dL). CSF and blood culture were negative. PCR with CSF for Borrelia was negative. Three days after initiation of ceftriaxone the patient became almost free of pain and started to spontaneously contract the detrusor, to partially void, and to develop a feeling of filling and emptying of the bladder (Figure 1). Only during two days anuria recurred. He developed a normal urine stream and the residual urine volume continuously decreased (Figure 1).

Bottom Line: Extensive urological investigations did not reveal a specific cause, which was why neurogenic bladder dysfunction was suspected.Neurologic exam revealed only mildly reduced tendon reflexes.Ceftriaxone may result in progressive recovery of bladder dysfunction and pain.

View Article: PubMed Central - PubMed

Affiliation: Krankenanstalt Rudolfstiftung, Postfach 20, 1180 Vienna, Austria.

ABSTRACT
Only few cases with sacral radiculitis due to infection with Borrelia burgdorferi leading to neurogenic urinary dysfunction have been reported. A 57-year-old male developed urethral pain and urinary retention, requiring permanent catheterization. Extensive urological investigations did not reveal a specific cause, which was why neurogenic bladder dysfunction was suspected. Neurologic exam revealed only mildly reduced tendon reflexes. Cerebral and spinal MRI were noninformative. CSF investigations, however, revealed pleocytosis, elevated protein, and antibodies against Borrelia burgdorferi. Intravenous ceftriaxone for three weeks resulted in immediate improvement of bladder dysfunction, with continuous decline of residual urine volume and continuous increase of spontaneous urine volume even after removal of the catheter and initiation of self-catheterization. Sacral radiculitis due to infection with Borrelia burgdorferi is a potential cause of detrusor areflexia and urethral, perineal, inguinal, and scrotal pain and may be misinterpreted as cystitis or urethritis. Ceftriaxone may result in progressive recovery of bladder dysfunction and pain. Neuroborreliosis may manifest exclusively as neurourological problem.

No MeSH data available.


Related in: MedlinePlus