Autism Symptoms Improve with Lyme Disease Treatment: A Case Report

A 14-year-old boy with autism spectrum disorder experienced substantial improvement in cognitive and neuropsychiatric symptoms following treatment for Lyme disease and Bartonella, according to a recent case report by Offutt and Breitschwerdt. Academic testing improved from special education level to tenth grade level, oppositional behavior resolved, and the patient was eventually accepted into a 4-year university.

Clinical perspective: This report describes a single patient and cannot establish causation. It highlights the possibility that treatable infections may contribute to neuropsychiatric symptom burden in select cases.

This case raises important questions about the role of tick-borne infections in neuropsychiatric presentations and the potential for recovery when underlying infection is treated.

Neuropsychiatric symptoms can be part of pediatric Lyme disease and other tick-borne infections. For an overview of diagnostic challenges in children, see Pediatric Lyme Disease.

The CDC notes that Lyme disease can affect the nervous system and produce neurologic symptoms in some patients. Learn more from the CDC.

For a broader discussion of how Lyme disease can be overlooked in children, see Pediatric Lyme Disease: Why Children Are Often Misdiagnosed.

Years of Unexplained Symptoms

The 14-year-old boy had been sick for years with neurologic and psychiatric issues. He had visited several physicians seeking an explanation for the fluctuating nature of these symptoms.

His severe symptoms included ADD/ADHD, tics (neck roll), anxiety, baby talk and immaturity, dysgraphia, oppositional behavior, low reading comprehension, stammering, depression and anger, picky eating, and bed wetting.

On multiple occasions, the young man had behavioral outbursts, which led to his running away from home.

Multiple Diagnoses Over the Years

He had received several diagnoses over time. These included cerebellar hypoplasia (in utero), ADHD (onset at age 5), PANS—pediatric acute-onset neuropsychiatric syndrome (onset during elementary school; officially diagnosed at age 10), autism (onset during elementary school; diagnosed at age 14), and autoimmune encephalopathy (diagnosed at age 14).

At age 10, the Cunningham Panel™ of tests revealed the presence of anti-neuronal antibodies with a borderline anti-Tubulin assay. At age 14, he was diagnosed with autoimmune encephalitis and began treatment with intravenous immunoglobulin (IVIG), which temporarily improved his symptoms.

Discovery of Tick-Borne Infections

Further testing revealed the young man had been exposed to several tick-borne infections with serologic evidence of Bartonella and Lyme disease.

The patient was prescribed various treatments for Lyme disease and Bartonella. The list included amantadine, doxycycline, minocycline, amoxicillin, amoxicillin/clavulanate, clindamycin, IV ozone, gluten-free diet, and a dairy-free diet.

Initial antibiotic attempts failed due to severe side effects and symptom flares. The treatment team adapted by introducing medications gradually.

A new therapeutic regimen was implemented, gradually administering individual or combinations of multiple different antimicrobial agents, including disulfiram, rifampin, minocycline, rifabutin, clarithromycin, and methylene blue. Other therapies included probiotics, antioxidants, and anti-inflammatories.

The treatment regimen described reflects the approach used in this individual case and should not be interpreted as a standard treatment protocol.

Improvement in Cognitive and Behavioral Symptoms

Antibiotic treatments resulted in substantial improvement in cognitive and neurobehavioral symptoms. Oppositional behavior and anger improved almost immediately after the initiation of disulfiram and these symptoms remained clear throughout the treatment period.

Academic testing transitioned from the special education level to tenth grade level. He no longer required the special accommodations that had been provided at his school.

He transitioned to a regular classroom and was able to maintain adequate academic performance. He improved his social skills, took a college entrance examination, and was accepted into a 4-year university.

Unfortunately, he was unable to discontinue the antibiotics without a flareup.

Key observation: After treatment for tick-borne infections, the patient transitioned from special education placement to regular academic coursework and was accepted to a 4-year university.

Clinical Implications

The authors granted that their patient had a well-defined embryonic abnormality diagnosed in utero. Yet, a decision was made to treat with antimicrobial agents targeting a potential infectious etiology, with secondary auto-antibody formation.

They encouraged further research to define the extent to which occult infections can contribute to neuropsychiatric illness and symptoms associated with autism spectrum disorder.

Neuropsychiatric manifestations of Lyme disease are discussed further in our overview of neuropsychiatric Lyme disease.

Clinical Takeaway

This case demonstrates that some children with autism spectrum disorder and concurrent tick-borne infections may experience substantial improvement in cognitive and behavioral symptoms when the underlying infections are treated. The patient’s progression from special education to university acceptance represents a remarkable functional recovery.

While this patient had a pre-existing embryonic abnormality, the dramatic improvement following antimicrobial treatment suggests that infectious triggers may have been exacerbating his neuropsychiatric symptoms. When autism symptoms fluctuate in severity, include physical manifestations, or occur after outdoor exposure in endemic areas, evaluation for tick-borne infections should be considered.

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