CASE REPORTS Human Coinfection with Bartonella henselae and Two Hemotropic Mycoplasma Variants Resembling Mycoplasma ovis

CASE REPORT A 49-year-old man with a 15-year history of intermittent numbness of the left leg and left hand subsequently developed an acute febrile illness (39.2°C) with nausea and malaise that abated over a 1-week period. In the subsequent months, progressively severe neurological symptoms developed, which included stumbling during jogging, muscle weakness, and fatigue, which were thought to be associated with a viral neuropathy. During the next year, running became impossible, the patient could not walk unaided, he developed leg myoclonus and numbness of the hands, and resting two to three times a day was required. Routine laboratory testing was unremarkable. Magnetic resonance imaging (MRI), performed 6 years before and 6 months after the onset of febrile illness, showed progressive multifocal paraventricular lesions of the white matter in the brain and spinal cord suggestive of a demyelinating disease. Tibial nerve conduction velocities were slightly slowed, consistent with a mild to moderate demyelinating peripheral neuropathy. Cerebrospinal fluid analysis, which had been performed before the onset of febrile illness, revealed the presence of oligoclonal bands in the absence of corresponding serum bands. Ultimately, on the basis of these findings, multiple sclerosis (MS) was diagnosed. Methylprednisolone sodium succinate (1 g) was administered intravenously once daily for 5 days in early 2005, prior to the diagnosis of MS, and again