A 65-year-old woman on hormonal therapy for breast cancer presented to the Emergency Department with sudden facial paralysis — Bell’s palsy. One week prior, she began having burning back pain radiating to the abdomen, which had grown worse. Over the past several months, she had suffered from worsening constipation.

Zulfiqar and colleagues described this case in an article entitled “The many manifestations of a single disease: neuroborreliosis,” published in the Journal of Community Hospital Internal Medicine Perspectives.

Stroke, Herpes, or Lyme Disease?

The woman was admitted to the hospital for a suspected stroke. However, brain CT and MRI showed no evidence of stroke. Doctors also suspected herpes zoster infection and prescribed valacyclovir.

The patient worked frequently in her backyard and was exposed to wooded areas. She recalled having a rash on her stomach 11 days before being admitted. Lyme serum antibody testing was positive for both IgG and IgM, with confirmatory Western blot showing multiband reactivity. Spinal tap results were also positive for Lyme disease.

She was diagnosed with neuroborreliosis and treated with oral doxycycline.

Constipation and Abdominal Pain Worsened

While hospitalized, the patient developed diffuse abdominal pain, abdominal distension, and worsening constipation.

An abdominal x-ray showed mild ileus. CT abdomen with contrast suggested constipation without obstruction or significant ileus. A colonoscopy was also normal.

She was additionally diagnosed with Syndrome of Inappropriate Anti-diuretic Hormone (SIADH) based on a sodium of 129 and typical urine findings.

Constipation as a Neurologic Symptom

The authors highlight several studies demonstrating a range of gastrointestinal problems — including constipation, ileus, and pseudo-obstruction — associated with Lyme neuroborreliosis. These GI symptoms are not primary digestive disorders but manifestations of autonomic dysfunction affecting gut motility.

Case reports have documented pseudo-obstruction, constipation, and back pain radiating to the abdomen — a pattern known as Bannwarth Syndrome — as autonomic manifestations of neuroborreliosis. Patients can develop worsening constipation and obstipation as diagnosis and treatment is delayed, leading to diffuse bowel dilation in the absence of mechanical obstruction.

This patient also suffered from anorexia with a loss of 14 pounds. One study found that 23% of 314 patients with early Lyme disease suffered from anorexia.

Clinical Perspective

This case illustrates how constipation and Lyme disease can be connected through autonomic nerve dysfunction — a mechanism that standard GI testing does not evaluate. When constipation appears suddenly, worsens despite treatment, and occurs alongside neurologic symptoms like Bell’s palsy, radicular pain, or fatigue, the clinical picture points away from a primary GI disorder and toward a systemic infection.

The authors conclude that Lyme disease should be suspected in patients from endemic areas who present with abdominal pain, constipation, and SIADH — with or without cranial nerve palsy.

Frequently Asked Questions

Can Lyme disease cause constipation?
Yes. Lyme neuroborreliosis can disrupt autonomic nerve function controlling gut motility, leading to constipation, ileus, and even pseudo-obstruction.

What is Bannwarth Syndrome?
Bannwarth Syndrome is a presentation of Lyme neuroborreliosis that can include radicular pain, cranial nerve palsy, and autonomic symptoms including constipation and abdominal pain.

Why did constipation worsen despite treatment?
Autonomic nerve dysfunction from Lyme disease can progress even after initial antibiotic treatment begins. Recovery of gut motility may take longer than resolution of other symptoms.

What is SIADH and how is it related to Lyme disease?
SIADH (Syndrome of Inappropriate Anti-diuretic Hormone) causes low sodium levels. It has been reported in association with Lyme neuroborreliosis, likely reflecting central nervous system involvement.

How is Lyme-related constipation different from typical constipation?
Lyme-related constipation tends to appear suddenly, worsens despite standard treatments, and occurs alongside neurologic symptoms — unlike typical constipation which develops gradually and responds to dietary or lifestyle changes.

References

1. Zulfiqar S, Qureshi A, Dande R, Puri C, Persaud K, Awasthi S. The many manifestations of a single disease: neuroborreliosis. J Community Hosp Intern Med Perspect. 2021;11(1):56–59.

Related Reading

• Lyme Disease Pain: Why It Moves and What Helps
• Lyme Disease Abdominal Pain: Why Every Test Was Normal
• Stomach Pain and Lyme Disease: A Case That Fooled Everyone
• Lyme Disease Gut: Digestive Symptoms Explained
• Autonomic Dysfunction in Lyme Disease
• Lyme Disease Back Pain: A Mystery Solved After 9 Months