a SciTechnol journal Case Report Turkoglu et al, J Neurosci Clin Res 2018, 3:1 Journal of Neuroscience & Clinical Research All articles published in Journal of Neuroscience & Clinical Research are the property of SciTechnol, and is protected by copyright laws. Copyright © 2018, SciTechnol, All Rights Reserved. International Publisher of Science, Technology and Medicine Neuroboriellosis and Associated Myoclonus in a Patient with Kartegener’s Syndrome Sule Aydin Turkoglu 1 *, Fatma Sirmatel 2 , Hayriye Orallar 3 , Siddika Halicioglu 4 , Serpil Yildiz 1 , Erol Ayaz 5 and Nebil Yildiz 1 Abstract Kartegener’s Syndrome is an autosomal recessive disease with primary ciliary dyskinesia. It has a triad of bronchiectasis, dextrocardia or situs inversus and chronic sinusitis. Lyme disease is a multisystem illness. It is referred to as neuroboriellosis if neuropsychiatric involvement is predominant. Myoclonus is a rapid and short hyperkinetic motion disorder. Its secondary etiology is located in the subset of post infectious disease. In this case report we are presenting a female patient of 38 year old known to have Kartegener’s Syndrome who had myoclonic contractions. In the etiological work up, no other fnding other than acute infection with Borrelia burgdorferi was found. Lyme disease is a rare etiological factor in involuntary movements, which directed us to prepare this case report. Keywords: Myoclonus; Lyme disease; Neuroboriellosis; Kartegener’s syndrome *Corresponding author: Sule Aydin Turkoglu, MD, Department of Neurology, Abant Izzet Baysal University Hospital, 14280, Bolu, Turkey, Tel: +903742534618; Fax: +903742534615; E-mail: suleaydinturkoglu@hotmail.com Received: November 14, 2016 Accepted: January 02, 2018 Published: January 08, 2018 In this case report we are presenting a 38 year of female patient known to have Kartegener’s Syndrome who had myoclonic contractions. In the etiological work up no other fnding than acute infection with Borrelia burgdorferi was found. Lyme disease is a rare etiological factor in involuntary movements, which directed us to prepare this case report. Case Report A 38-year-old woman living in the village working as a farmer, admitted to the outpatient neurology clinic with myoclonic contractions which increased gradually for the last 4 years. She has been followed for Kartegener’s Syndrome (bronchiectasis, situs inversus and chronic sinusitis) for 20 years. Her solid organs located in the abdomen and thorax on the opposite location (Figure 1). She has been followed for Bronchiectasis and pansinusitis by the Clinics of Pulmonary Medicine and ENT. She had immotile cilia and anosmia and she had been treated for Pneumonia caused by Pseudomonas Aeruginosa. In the ultrasound imaging of the abdomen, it was seen that the solid abdominal organs were located on the opposite side. Te patient has been experiencing numbness on the right foot which was relieved by motion, right knee pain and difculty in standing up for approximately 5 years. She also had stabbing type back pain and pain that was aggravated by deep inspiration. Te patient experienced fasciculations in her body, legs and sometimes in her face which was sometimes accompanied by a brief jerk. Tese involuntary movements happened while she was asleep. She was admitted to a neurology outpatient clinic but no pathological fnding was discovered in the EEG. She was prescribed valproic acid for involuntary movements. Te patient experienced partial relief. Acute pansinusitis and otitis were the only pathological fndings in the cranial CT and MRI (Figure 2). Her treatment was modifed with the addition of levetirasetam and the cessation of valproate. Te patient experienced partial relief with the new treatment as well and for the last year she had 20 daily involuntary movements all through her body. She has been experiencing knee pain and occasionally fever. Abbreviations SEP: Somatosensory Evoked Potential; MRI: Magnetic Resonance Imaging; EEG: Electroencephalography; CT: Computed Tomography; MS: Multiple Sclerosis; ENT: Ear-Nose-Troat; HRCT: High Resolution Computed Tomography Introduction Kartegener’s Syndrome is an autosomal recessive disease with primary ciliary dyskinesia. It has a triad with bronchiectasis, dextrocardia or situs inversus and chronic sinusitis [1]. Lyme Disease (LD) is an infectious disease caused by Borrelia burgdorferi. Tis infectious agent is a spirochete transmitted by tick bites [2]. Being a multisystem disease, LD manifests itself with dermatologic, skeleton-muscular and neuropsychiatric symptoms [3]. Atypical fndings can be absent in neuroboriellosis. Tese are, acute idiopathic polyneuritis, urinary retention, hyponatremia, sensory defcits, visual hallucinations and constipation [4]. Myoclonus is a rapid and short hyperkinetic motion disorder. It is divided into three groups according to etiology; physiological, essential and epileptic. Secondary myoclonus may result from cortical or subcortical disease. Among the secondary reasons, postinfectious encephalitis belongs to the subset of cortical reasons [5]. Figure 1: Chest x-ray (a), extensive varicose bronchiectasis in two lungs can be seen in HRCT sections (b and c). In Chest x-ray dextrocardia and stomach bubble located at the right side (situs inversus totalis) can be seen as well.