Lyme disease –induced polyradiculopathy mimicking amyotrophic lateral sclerosis

Abstract

The diagnosis of Lyme disease can be very challenging and it can mimic other neurological disorders such as ALS or Guillain-Barre syndrome (GBS). Careful and detailed examination and investigation are required to confirm the diagnosis and to prevent misleading inaccurate diagnoses.

Relevance of Chronic Lyme Disease to Family Medicine as a Complex Multidimensional Chronic Disease Construct: A Systematic Review

“…A factor that complicates the diagnosis of CLD is that it does not present with isolated subjective symptoms [ 47 ]. In undiagnosed patients or posttreatment, Bb may mimic the symptoms and signs of other diseases disorders [ 80 , 81 ] and for this reason is called “the illness with a thousand faces.” Patients present themselves with a wide variety of (often unrelated) clinical manifestations [ 82 ]. These symptoms may include fatigue [ 83 ], insomnia [ 49 ], widespread pain [ 19 ], arthritis [ 84 ], chronic eye lid edema [ 85 ], cataract [ 86 ], dermatitis [ 87 ], cognitive complaints [ 19 ], bilateral hearing loss [ 88 ], adult respiratory distress syndrome [ 89 ], palpitations, tachycardia [ 90 ], syncope [ 87 ], tremors, epileptic crises [ 91 ], depression, anxiety, panic attacks, catatonia, and psychosis [ 92 ], amongst others [ 93 , 94 ].…”

“…These symptoms may include fatigue [ 83 ], insomnia [ 49 ], widespread pain [ 19 ], arthritis [ 84 ], chronic eye lid edema [ 85 ], cataract [ 86 ], dermatitis [ 87 ], cognitive complaints [ 19 ], bilateral hearing loss [ 88 ], adult respiratory distress syndrome [ 89 ], palpitations, tachycardia [ 90 ], syncope [ 87 ], tremors, epileptic crises [ 91 ], depression, anxiety, panic attacks, catatonia, and psychosis [ 92 ], amongst others [ 93 , 94 ]. Lyme disease might become misdiagnosed as fibromyalgia [ 95 ], chronic fatigue syndrome [ 96 , 97 ], amyotrophic lateral sclerosis [ 80 ], autism spectrum disorder [ 98 ], Parkinson's disease, rheumatoid arthritis [ 99 ], multiple chemical sensitivity, Guillain-Barre syndrome (GBS) [ 80 ], and dementia [ 100 ], as well as other numerous neurological [ 101 , 102 ] and psychiatric disorders [ 88 , 103 ]. Caution is however warranted as misdiagnosis of CLD may result in unnecessary antibiotic courses [ 104 ].…”

Unusual Presentation of Unilateral Isolated Probable Lyme Optic Neuritis

“…Ceftriaxone, cefotaxime, penicillin G, and doxycycline are highly effective in most neurological Lyme cases [ 6 , 7 , 14 – 17 ]. Intravenous ceftriaxone, high-dose penicillin, and cefotaxime have been used in patients with severe disease, particularly nervous system infection, and in patients who have not responded to oral regimens.…”

“…Intravenous ceftriaxone, high-dose penicillin, and cefotaxime have been used in patients with severe disease, particularly nervous system infection, and in patients who have not responded to oral regimens. European studies [ 6 , 14 , 15 , 18 – 22 ] have shown that oral doxycycline, which achieves spirochetocidal concentration in the central nervous system (CNS), is highly effective in Lyme meningitis, cranial neuritis, and radiculoneuritis. In our case, the patient had a favorable improvement with oral doxycycline treatment; most of the reported Lyme ON cases were treated with ceftriaxone [ 11 , 12 , 16 , 17 , 23 , 24 ].…”

“…Lyme disease (LD), the leading arthropod-borne infection in the northern hemisphere, can cause a wide spectrum of neurological conditions involving central and peripheral nervous systems [ 6 – 8 ]. LD-related ocular complications are uncommon, but various types of manifestations have been described including conjunctivitis, keratitis, and extra-ocular muscle palsies [ 8 , 9 ].…”