Lyme disease involving bilateral cerebellar peduncles

Materials & Methods A 28-year-old male presented with numbness and tingling of the right side of his face. Physical examination revealed mild right facial weakness, first-degree left beating nystagmus and decreased sensation in the right trigeminal nerve distribution. MR imaging revealed bilaterally symmetric increased signal on T2 and FLAIR in the cerebellar peduncles. The remainder of the MR imaging was normal. PET scanning utilizing Flourine-18-FDG was performed to rule out neoplasm. There were hypermetabolic foci in both cerebellar peduncles resulting in a falsepositive result for neoplasm and a neurosurgical consultation. Workup for multiple sclerosis was negative. CSF analysis revealed an increase in Borrelia burgdorferi-specific antibodies relative to serum. The patient improved on iv Rocephin.