An unexpected case of Borrelia garinii liver infection - INRAE - Institut national de recherche pour l’agriculture, l’alimentation et l’environnement Access content directly
Journal Articles Annals of Clinical Microbiology and Antimicrobials Year : 2022

An unexpected case of Borrelia garinii liver infection


Background Lyme borreliosis is the most prevalent arthropod-borne infection in the Northern Hemisphere. In Europe, Borrelia afzelii is predominantly involved in cutaneous manifestations, Borrelia garinii and Borrelia bavariensis in neurological manifestations, and Borrelia burgdorferi sensu stricto in articular ones. Liver impairement is not classical in Lyme borreliosis. Diagnosis is currently mainly based on serological testing, and is challenging in immunocompromised patients. Case presentation We report the first case of B. garinii infection revealed by liver involvement in an immunocompromised man. A 73-year-old man with marginal zone lymphoma, treated with bendamustine and rituximab, developed intermittent fever and inflammatory syndrome. Microbial investigations were all negative and FDG-PET showed complete remission of the lymphoma. Three months later, liver biopsy was performed and histology revealed spirochetes-like bacteria. Microbial diagnosis was performed by 16S rDNA sequencing, flagellin ( fla B) gene sequencing and multi-locus sequence typing and identified B. garinii . The patient recovered successfully after a three weeks course of antibiotics. Diagnosis was challenging because Borrelia hepatic involvement is unusual and no erythema migrans nor tick bite were notified. Conclusion This case highlights that unexplained fever and inflammatory syndrome in immunocompromised patients warrants specific investigations to identify bacteria such as spirochetes.
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hal-04161250 , version 1 (13-07-2023)




Pierre Duffau, Skander Korbi, Vivien Guillotin, Emilie Talagrand-Reboul, Armelle Ménard, et al.. An unexpected case of Borrelia garinii liver infection. Annals of Clinical Microbiology and Antimicrobials, 2022, 21 (1), pp.15. ⟨10.1186/s12941-022-00506-6⟩. ⟨hal-04161250⟩
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