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Leptomeningeal carcinomatosis is a serious complication of advanced cancer. Various clinical manifestations may present, such
as headache, nausea, seizures, cranial neuropathies. In this article, we report the case of a 65-year-old woman with metastatic
breast cancer who was admitted to hospital suffering from facial palsy, which was suspected to be caused by leptomeningeal
tumor infiltration. Magnetic resonance imaging (MRI) scans of the head and spine showed meningeal enhancement of the
facial nerve, conus medullaris, and fibers of the cauda equina, which were radiologically interpreted as leptomeningeal
carcinomatosis. Assessment of cerebrospinal fluid found no malignant cells but investigation for infectious diseases established
the diagnosis of neuroborreliosis. Antibiotic treatment with doxycycline was performed. After completion of treatment,
follow-up MRI scans found complete regression of meningeal enhancement. Several months later, the patient is still in
good condition and without neurological symptoms. Hence, initial diagnosis of leptomeningeal carcinomatosis was rejected.
This case report should alert oncologists to carefully rule out infectious diseases before leptomeningeal carcinomatosis is
diagnosed. Cerebrospinal fluid analysis is strongly recommended due to low specificity of MRI images in this regard.