J Med Lyon 1922;71:765-767.
Garin CH, Bujadoux C.
Abbreviated case-story
translated from French by Marie Kroun
June 14, 1922: JMB, 58 years old, got a tickbite
by Ixodes hexagonus on his left buttock.
He knew the tick well from bites on his dog and sheep, and removed it without
damaging its head.
Three weeks later, he was hit by a very rapidly developing, painful disease, with alarming stabbing pains. After this, irradiating pain developed in his left ischiadicus and he consulted dr. HINGLAIS, who saw a red inflamed area on the left buttock, with the tickbite in its center, the size of a 5 Franc coin. It was red, warm, painful and with palpable inguinal lymphglands on the same side. Later the rash increased in size into a wide, confluent one, without vesicles, which ultimately covered his left and right buttock, hypochondriac area, lower part of truncus and left leg down to the knee.
No fever. Urine normal. In the same area as the rash, the diseased suffered from severe pain, including a belt around the thorax and in right plexus brachialis area with irradiating pain down to the elbow. He suffered terribly, without any relief from 'antineurotique' medicine and also morphica had no or only transient effect.
In July an August, i.e. during 2 1/2 month, he suffered tremendously.
On Sep. 19, he travelled by automobile to dr. GARIN, who
noted the following:
Lungs and heart normal. Pulse 96. Temp. 37.5. Liver not palpable. Left sided neck adenitis, as a chain of small glands along m. sternocleidomastoideus, but none in axillae, genitalia or inguinal regions.
Nervous system: paresis of right m. deltoideus with atrophy, it
was impossible for him to lift his arm, otherwise normal movements. No
objective sensory disturbances, but the patient describe 2 very painful
spots at the basis of thorax and belt-formed pain corresponding to the 2 lowest
intercostal nerves, causing breathing difficulty. These pains were
alleviated after the first injection of novarsenobezol. No trophic disturbances
on the lower extremities. Normal tendon reflexes. Normal pupil-reaction.
The sick man is very disturbed, having chills and being restless.
Oct. 3. Same findings, but when asked to sit up, a slight
positive Kernig.
Lumbarpuncture the same day
reveals, spinalfluid under pressure, glucose normal, increased
albumin, 75 WBCs mostly polymorphonuclear cells. No microbes, no
spirochetes visible. Wassermann reaction slightly
positive.
Oct. 17. The symptoms have improved and the patient is
discharged, but he still have reduced movement in his right arm and atrophy of
the deltoid muscle and he still suffers some pains at the basis of the thorax.
Treatment: from Sep. 26 - Oct. 16 he was given 4 injections of neo-billon, 0.10, 0.30, 0.45, 0.60 cgr. - the last three times preceded by cyan Hg.
Notably the most severe pain was relieved after the first injection of novarsenobenzol.
Seen in the outpatient clinic
on Oct. 30 and Nov. 8, where he does not suffer much, but still have reduced
movement of the right arm.
Authors discussion:
This case seem to be a case
of 'tick paralysis'. The Wassermann reaction was slightly positive, but that is sometimes the case in other tick-borne diseases like
Rocky Mountain Spotted fever and relapsing fever. On the other hand, does this man not have any sign of syphilis.
In experiments, HAWDEN, in
It is possible to infect
lambs and pheasants via a tickbite. The illness shows about 6-7 days after the bite. It is not possible
to reproduce the illness via injection of blood from a sick into an animal. He
did not find the pathologic agent. Regarding the etiology, the english authors
suspects that an infectious agent is transmitted by the tick, or a toxin is
being inoculated.
We also admit
voluntarily that it must be an agent (virus) transported by the tick.
This hypothesis is supported
by the adminstration of novarsenobenzol to our patient, that was very effective
in alleviating the severe pain. Our observation differs
from others in the english literature, that our patient had a rash after the
tickbite, and it also differs regarding the tick that was responsible for
causing this disease, in our case it was an Ixodes hexagonus tick.
We propose to collect ticks from the patients village and try to produce the illness in an animal via tickbite.