Neurologic Lyme disease presenting as abdominal pain in 71-year-old patient

“Although abdominal pain is generally not considered a sign of LD [Lyme disease], in this case report we describe a patient with unexplained severe abdominal pain that eventually turned out to be LD due to radiculopathy,” explains Stolk from the Haga Teaching Hospital in the Netherlands. [1]

 

by Daniel J. Cameron, MD, MPH

The 71-year-old woman underwent an exhaustive evaluation to determine the cause of her abdominal pain. Tests included: CT scan of the chest and abdomen; whole body emission tomography-CT scan (PET-CT); colonoscopy; gastroscopy, and an MRI of the small intestines.

abdominal pain, stomach ache

Case report: Abdominal pain is the first clinical manifestation of Neurologic Lyme disease in elderly woman.

She was admitted for pain management and other diagnostic workups. Eight weeks prior to her hospitalization, she experienced temporary lower back pain, myalgia, fever, burning sensations and tenderness on her head and upper legs and moderate abdominal pain. Several weeks later, her abdominal pain worsened.

“Going over the history again, she emphasized that she had stayed in a high endemic area for ticks and had suffered a possible tick bite without any sign of erythema migrans,” writes Stolk and colleagues.

Serologic testing and a spinal tap were consistent with Neurologic Lyme disease. The spinal tap revealed an elevated IgM antibody to Borrelia burgdorferi (Bb), a lymphocytic pleocytosis, markedly elevated IgM antibody index to Bb, and markedly elevated IgG antibody to Bb.

Case report: When abdominal pain is the main manifestation of neuroborreliosis. Click To TweetThe authors point out that “Since the incidence of LD is rising it is important to realise that severe abdominal pain could be the first clinical manifestation of early neuroborreliosis.

The woman was prescribed a two-week course of intravenous ceftriaxone. And, the abdominal pain resolved.

This case demonstrates the importance of re-examining a patient’s history when symptoms cannot be explained. “Instead of doing extensive diagnostic tests, it is important to scrutinize the patient’s medical history in the presence of unexplained clinical signs,” the authors conclude.

Stolk and colleagues note: Abdominal pain in the presence of facial paralysis has been described in Europe as Bannwarth syndrome.

Editor’s note: I often see Lyme disease patients in my practice who present with abdominal pain severe enough to warrant extensive diagnostic testing before Lyme disease is suspected.

 

Related Articles:

Long-term problems for some Lyme neuroborreliosis patients

What happens to the brain during acute Lyme neuroborreliosis?

Ever wonder what is happening in the brain of Neurologic Lyme disease patients who remain ill after treatment?

References:

  1. Stolk JM, van Nieuwkoop C, van der Voorn M, van Erp S, van Burgel ND. Ticking off diagnoses of abdominal pain: early neuroborreliosis with radiculopathy. Neth J Med. 2018;76(7):336-338.


8 Replies to "Neurologic Lyme disease presenting as abdominal pain in 71-year-old patient"

  • Pam Pangle
    10/22/2018 (9:15 pm)
    Reply

    Why do these things ALWAYS get limited to the ‘patient living in/visiting an endemic region/area’? I have had severe abdominal pain that should have been investigated as a possible tick-borne infection (because that’s what it proved to be- as treatment for said infection has alleviated a lot of pain), and yet because I have never lived in what was considered an ‘endemic region’, I was never tested until I took it upon myself to seek out testing.

    There are thousands of people that live outside what is considered to be ‘endemic areas/regions’ and our symptoms and health issues are ignored, even when they match up perfectly to the symptoms of those living in endemic areas. And do NOT say the words “Lyme” or “Lyme disease” while searching for answers, as you will be completely shut out of all services like I was.

    Such a sad statement about the narrow mindedness of these researchers and those that create these ‘rules’.

  • Jane Woods
    01/02/2019 (9:35 am)
    Reply

    The most common kind of abdominal pain is a stomach- or bellyache, which happens from time to time throughout our lives. People with abdominal pain often double over, clutch their gut, feel nauseated or dizzy, and avoid food and water. The first step to addressing mild stomach pain not associated with a medical condition or trauma is to try to identify and avoid the trigger. For example, overeating or eating rich or gas-inducing food can cause heartburn, distended stomach, and abdominal pain, which can be avoided by practicing dietary changes and moderation. You can also refer to this article which states all the necessary details about abdominal-pain https://www.everydayhealth.com/abdominal-pain/guide/

    • Dr. Daniel Cameron
      01/02/2019 (1:45 pm)
      Reply

      I have patients who have been told that Lyme disease is not a symptoms of Lyme disease. It is common and worth further study. In some cases the stomach pain is relate to autonomic issues in Lyme disease. There are often other issues beyond the stomach that help with the diagnosis.

  • Pamela Otto
    02/20/2019 (2:08 am)
    Reply

    I am suffering with really bad stomach pain. I have chronic Lyme. I was told I have parasites as well. is Ceftriaxone well tolerated? I am just not even eating because its so uncomfortable. any thoughts? Pamela-getting desparate!!!

    • Dr. Daniel Cameron
      02/20/2019 (2:00 pm)
      Reply

      I find IV ceftriaxone is typically well tolerated in my patients. I start the first dose in my office in case there is an allergic reaction. I advised a low fat diet due to risk of gall bladder sludging. I am primarily concerned with risk of a central line e.g. infections an clots. I typically changed the oral medications first before IV. I also use the time on oral to rule out other illnesses.

  • Kevin
    04/11/2019 (6:06 pm)
    Reply

    At least this women got treated at a hospital and they found out it was nueroborreliosis. I went to the hospital twice and they did nothing but give me but say we can’t find anything answer. I was and still am in severe pain and even no spinal fluid check. I do have lyme and 3 cos.

  • Kevin Fitzgerald
    04/22/2019 (4:01 pm)
    Reply

    I went yrs and yrs undiagnosed. Because of not knowing when I got bit and had no rashes. But I did have many weird ailment going on throughout the yrs. I did get medicine to treat the bandaid ailments Drs never ever checked me for Lyme. So over the yrs this infection just ballooned into this huge problem which hit me all at once and then I got the same treatment. Every kind of specialist tests came back normal. Still felt severely sick. But the Drs could’ve thought of a disease specialist 2 yrs earlier and I would’ve known what I had. I was the one who put the missing piece in in what specialist i wasn’t sent too. I had one set up at a hospital. But I needed a referral from the Dr. But the Dr had canceled it and made the app for something I had which was normal.

    • Dr. Daniel Cameron
      04/25/2019 (12:52 am)
      Reply

      How frustrating.


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