Patient presented with fulminate demyelinating encephalitis later diagnosed as adult ADEM (acute demyelinating encephalitis) which is a very rare monophasic condition with an unknown autoimmune source; in a coma within 24hrs of initial symptoms. Patient is now fully recovered having responded quickly to plasmapheresis. Initial battery of diagnostic testing run at ER included a Western Blot on the CSF, given our geographic location, which later showed positive IgG 5/10 bands (p93, p58, p41, p39, p23) and negative IgM 1/3 (p41). All lyme blood work then and now are negative, only positive on the CSF. Medical teams strongly believes that the presentation and imaging were inconsistent with lyme encephalopathy and that the test is an unrelated finding. Some doctors believe we should begin treatment (1 month IV Ceftriaxone) while others question the validity of the test due to the negative blood tests, no symptoms, no bite and the potential cross reactivity of the acute autoimmune event during which the CSF was drawn. I am leaning toward requesting another CSF test to rule out a false positive but we are not thrilled about another lumbar puncture.
What are your thoughts on the likelihood of cross-reactivity of a western blot lyme test to a severe autoimmune event? I cannot find literature that speaks specifically to this, only references that when I obtain the studies appear to be about cross-reactivity with ELISA testing.
Other thoughts and recommendations?