Dr. Daniel Cameron: Inside Lyme Podcast

Abdominal pain, ileus and constipation due to Lyme disease

Welcome to another Inside Lyme Podcast. I am your host Dr. Daniel Cameron. In this episode, I will be discussing the case of a 65-year-old woman with abdominal pain, ileus/pseudo-obstruction and constipation due to Lyme disease.


Zulfiqar and colleagues first 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.¹

A 65-year-old woman on hormonal therapy for estrogen receptor-positive breast cancer presented to the Emergency Department with sudden seventh nerve palsy, commonly referred to as Bell’s palsy.

One week prior, she began having burning back pain radiating to the abdomen, which had grown worse and over the past several months had suffered from constipation.

Stroke, herpes virus or Lyme disease?

The woman was admitted to the hospital for a suspected stroke. However, there was no evidence of a stroke by brain CT or MRI.

Doctors also suspected she had a herpes zoster infection and prescribed valacyclovir, an anti-viral medication.

The patient worked frequently in her backyard and was exposed to wooded areas. She also recalled having a rash on her stomach 11 days before being admitted to the hospital.

“Lyme serum antibody (IgG and IgM) was positive with confirmatory Western blot resulting in multiband reactivity,” the authors write. Spinal tap test results were also positive for Lyme disease.

The woman was diagnosed with neuroborreliosis, or Lyme disease and treated with oral doxycycline.

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

An abdominal x-ray showed mild ileus. “CT abdomen with contrast was done which suggested constipation without obstruction or ‘significant’ ileus,” the authors explain. A colonoscopy was also normal.

The woman was also diagnosed with Syndrome of Inappropriate Anti-diuretic Hormones (SIADH) based on a sodium of 129 and typical urine findings.

Abdominal pain, gastrointestinal problems in Lyme disease

The authors highlight several studies demonstrating a range of gastrointestinal problems, including abdominal pain, associated with Lyme disease.

“There have been many case reports in the past highlighting the atypical presentation of Lyme disease including, but not limited to pseudo-obstruction, constipation, back pain radiating to abdomen (radiculoneuritis) known as Bannwarth Syndrome as a manifestation of autonomic dysfunction related to neuroborreliosis,” the authors explain.

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.

Meanwhile, Shamim et al. reported two cases of patients who presented with severe constipation and hyponatremia in addition to other features of Lyme disease.

Lyme neuroborreliosis has also been reported as “the culprit of chronic intestinal pseudo-obstruction” in other studies, the authors explain. “The patients can develop worsening constipation and obstipation as diagnosis and treatment is delayed, leading to diffuse bowel dilation in the absence of mechanical obstruction.”

Lastly, “There have been a few case reports of SIADH associated with neuroborreliosis,” writes Zulfiqar.

Authors’ Conclusion: Lyme disease should be suspected in patients who are from Lyme endemic areas and present with abdominal pain, constipation and SIADH with or without cranial nerve palsy.

The following questions are addressed in this podcast episode:  

  1. Why was a stroke initially considered?
  2. Why was herpes zoster suspected?
  3. What are the causes of 7th nerve palsy?
  4. What is SIADH?
  5. What is ileus?
  6. What is Bannwarth Syndrome?
  7. How are GI issues related to autonomic dysfunction?

    Thanks for listening to another Inside Lyme Podcast. You can read more about these cases in my show notes and on my website @DanielCameronMD.com. As always, it is your likes, comments, reviews, and shares that help spread the word about Lyme disease. Until next time on Inside Lyme.

Please remember that the advice given is general and not intended as specific advice to any particular patient. If you require specific advice, then please seek that advice from an experienced professional.

Inside Lyme Podcast Series

This Inside Lyme case series will be discussed on my Facebook page and made available on podcast and YouTube.  As always, it is your likes, comments, and shares that help spread the word about this series and our work. If you can, please leave a review on iTunes or wherever else you get your podcasts.

  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. Jan 26 2021;11(1):56-59. doi:10.1080/20009666.2020.1831746

10 Replies to "Abdominal pain, ileus and constipation due to Lyme disease"

  • Amy Kuske
    09/10/2023 (5:32 pm)

    First I experienced 6th nerve palsy-ER ruled out stroke, tumor,MS. 3 days later I had severe back pains. I couldn’t sleep for 3 days so went back to ER. Diagnosed with constipation. Pain continued-I didn’t sleep for 2 weeks-return to Urgent Care and ER for the pain 2 more times. They kept telling me it was constipation so they couldn’t give me anything for the pain. Then 7th nerve palsy developed, so an ER doc connected the dots and ordered a Lyme test which was positive. After 2 months only the 6th nerve palsy remains. So glad the pain is gone-it was very intense across my back and abdomen. Praying my vision heals. I hope more health professionals get educated on these symptoms.

  • Yvonne
    06/05/2022 (4:16 am)

    The Lyme Disease Asscoiation of Australia linked this article, ironicallly same week I nearly ended up in hospital due to ileus. I have tried every gut thing known to man (diet shifts, probiotics, motility agents etc) and like many chronic patients, have had to do daily / twice daily enemas for years to avoid obstipation.
    My Lyme diagnosis is relatively recent – 4 years in 30 years of CFS/ fibromyalgia/ MCAS – but unfortunately the antibiotics and herbs haven’t improved the gut symptoms

    • Dr. Daniel Cameron
      06/06/2022 (6:25 am)

      There are so many overlapping issues affecting the gut. I hope they find an answer for you soon.

    06/03/2022 (9:05 pm)

    What treatment did this lady get. I have been sick with Lyme for 39 years. I wasn’t diagnosed until 4 years ago. Antibiotics didn’t help me.

    • Dr. Daniel Cameron
      06/04/2022 (4:46 pm)

      The authors did not specify the antibiotics used. I find that I have to individualize treatment for each patient.

    • Gail Nadler
      07/05/2022 (7:03 pm)

      I have a very similar situation to yours but with more details. Please contact me at gailtmbr@aol.com

  • Peter
    06/02/2021 (2:28 pm)

    Just wondering what treatment that lady got for her lyme.

    • Carrol Nuss
      06/04/2021 (1:01 pm)

      Great podcast! I sound like the case study but without breast cancer. This podcast makes me fight harder in education to my medical team. Thanks

  • Beverly Benson
    06/02/2021 (1:49 pm)

    I have had two very bad contraction episodes. The worst ever and I had 2 children one in her 40s and one almost 30. They are not fun. They paralyze you.

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