BMJ Case Reports 2018; doi:10.1136/bcr-2018-225801
  • Unusual presentation of more common disease/injury

Woman with lower back pain, SIADH and a twist of Lyme

  1. Dennis Michael Manning2
  1. 1Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
  2. 2Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr Omid Salaami, salaami.omid{at}
  • Accepted 13 September 2018
  • Published 7 October 2018


A 62-year-old woman was admitted with a 3-week history of atraumatic bilateral lower back pain, progressive ascending flaccid paralysis, hyponatraemia and constipation. She was otherwise in good health with only a recent diagnosis of acute gastroenteritis that preceded her presenting symptoms. Her initial laboratory evaluation was consistent with Syndrome of Inappropriate Antidiuretic Hormone (SIADH) but was otherwise unremarkable. MRI of the spine revealed bilateral diffuse nerve root enhancement from at least C6 to the conus level, suggesting an inflammatory process. Lumbar puncture demonstrated high protein (629 mg/dL) with marked pleocytosis (363 cells/mcL) incompatible with albuminocytological dissociation typically seen in Guillain-Barre syndrome. A thorough diagnostic evaluation was undertaken to explore potential infectious, malignant and autoimmune conditions. Lyme disease serology (ELISA and Western Blot, IgM and IgG) was positive leading to a final diagnosis of lymphocytic meningoradiculitis or Bannwarth syndrome.


  • Contributors DMM was the consulting physician while OS was the resident caring for the patient. DMM outlined the important clinical pearls and assisted with revision while OS drafted the report.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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