Case report: Meningitis secondary to Lyme disease

In this case report, “Meningitis in the Guise of Dementia: Lyme-Induced Normal Pressure Hydrocephalus,” Liu and colleagues review the case of an elderly patient with dementia, found to have Lyme meningitis in the setting of a normal pressure hydrocephalus (NPH). [1]

An 80-year-old man was admitted to a hospital in Pennsylvania, an area endemic for Lyme disease, due to increased weakness and confusion. He had “several days of nausea with decreased appetite, generalized malaise, fatigue, and weakness,” according to the authors.

Cerebrospinal fluid (CSF) studies suggested aseptic meningitis. And a CT scan showed dilated ventricles. Treatment for normal pressure hydrocephalus relieved his symptoms.

On the fourth day of hospitalization, the man tested positive for Lyme disease by Western blot on bands 23KD and 39KD.

“Healthcare providers treating patients with NPH should consider Lyme disease as a differential diagnosis because of the multiple reported cases of NPH secondary to Lyme disease.”

“The patient was subsequently diagnosed with aseptic meningitis secondary to Lyme,” the authors state.

He was treated with IV and oral doxycycline. But his dementia did not completely resolve, “likely due to primary dementia or other condition.”

“In the case of our patient, infectious meningitis was suspected due to this patient reportedly having had fevers and leukocytosis. Additionally, Lyme disease is among the most common reportable infections in Pennsylvania,” the authors state.

Authors Conclude:

“Lyme disease … can present with multiple complications, including arthritis, heart rhythm defects, facial nerve palsy, impaired memory, and meningitis. Hence, Lyme disease should be considered as part of the differential etiology of meningitis.”