Dr. Daniel Cameron: Inside Lyme Podcast

ALS mimicked lyme disease. A case report.

Hello, and welcome to another Inside Lyme Podcast. I am your host Dr. Daniel Cameron. In this episode, I will be discussing the case involving a 63-year-old man whose ALS mimicked lyme disease.

I first read about this case by Wirsching and colleagues in the journal Clinical Case Reports. [1]

Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease, is a progressive motor neuron disease.

The 63-year-old man developed bilateral atrophic arm paresis with preserved reflexes and met the criteria for probable ALS. However, he also tested positive for Lyme disease by spinal tap.

In the year prior to developing ALS symptoms, the patient reportedly had a tick bite without a rash.

“In July 2018, that is, within six months, he developed paraparesis of both arms and also suffered from cramps in the shoulder girdle and hand muscles,” wrote the authors. “By August 2018, the patient was severely impaired in everyday life activities.”

His spinal tap revealed pleocytosis (an elevated white count) and elevated protein. The spinal fluid was positive for IgM and IgG titers for Lyme disease. His blood test was positive by ELISA and IgG Western blot tests. The antibody index was higher in the spinal tap than the blood by IgM but not IgG.

AS ALS mimicked lyme disease, he was prescribed a three-week course of intravenous ceftriaxone but his symptoms did not improve.

“Hence, it is unlikely that neuroborreliosis was the main cause of symptoms in our patient,” wrote the authors.

Instead, the authors concluded that the patient’s ALS mimicked Lyme disease.

Considering Lyme disease in differential diagnosis

The authors of another study, suggested that Lyme disease should be considered in patients presenting with ALS. “There appears to be a statistically significant association between ALS and immunoreactivity to B burgdorferi.” [2] Subsequent larger studies did not show an association.

Although the association between these two diseases remains controversial, Wirsching et al. highlighted the importance of considering Lyme disease in an ALS workup.

“It is vital to exclude potentially treatable diseases in the differential diagnostic work-up of all patients not to miss seldom, but treatable differential diagnoses such as neuroborreliosis,” the authors concluded.

The following questions are addressed this podcast:

  1. What is ALS?
  2. What is the difference between motor and sensory nerve disease?
  3. Why was Lyme disease considered?
  4. What is the significance of the positive spinal tap for Lyme disease?
  5. Were there any other tick-borne infections discussed?
  6. Was a single 3-week course of IV antibiotics sufficient?
  7. Why is it important to consider reversible causes of ALS?
  8. Have you seen cases of motor nerve disease in your practice?

Editor’s note:

Harvey and Martz described the case of a patient with motor nerve disease (ALS) who improved with antibiotic therapy.[3]

I have had Lyme disease patients with motor neuron disease who have improved with antibiotic treatment and others who have failed. I continue to encourage research in this area.

    1. 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 as 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 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.

References:
  1. Wirsching I, Ort N, Uceyler N. ALS or ALS mimic by neuroborreliosis-A case report. Clin Case Rep. Jan 2020;8(1):86-91. doi:10.1002/ccr3.2569
  2. Halperin JJ, Kaplan GP, Brazinsky S, et al. Immunologic reactivity against Borrelia burgdorferi in patients with motor neuron disease. Arch Neurol. 1990;47(5):586-594.
  3. Harvey WT, Martz D. Motor neuron disease recovery associated with IV ceftriaxone and anti-Babesia therapy. Acta Neurol Scand. Feb 2007;115(2):129-31. doi:10.1111/j.1600-0404.2006.00727.x


3 Replies to "ALS mimicked lyme disease. A case report."

  • Marcia Stewart
    04/15/2022 (8:29 am)
    Reply

    With my amyotrophic lateral sclerosis (ALS), the first thing that happened almost 2 years ago now, was speaking as if I were drunk. I wasn’t. I initially did improve speech (articulating clearly but slow) but now I can no longer speak in an acceptable way. Then, a year later eating became problematic, I was biting my tongue and lips, and chewing became weak and less controlled. Soon after that some fingers started to fail me and things would drop out of my hands. Somewhere at that time bulbar ALS was diagnosed. The Rilutek (riluzole) did very little to help me. The medical team did even less. My decline was rapid and devastating.. We tried every shot available but nothing was working. There has been little if any progress in finding a reliable treatment, Our care provider introduced us to Kycuyu Health Clinic ALS/MND herbal treatment. The treatment is a miracle.i recovered significantly! I Adhere anyone reading this to try natural approach. ALS is not a death sentence.

  • Karen Strang
    04/14/2022 (7:36 am)
    Reply

    I love the fact that this information is getting out. We lost our youngest brother to non genetic so called ALS. I had a Lyme diagnosis after 3years of running to specialists back in 1994. And it was a huge struggle to shake my MS original diagnosis. Then when our brother got diagnosis I pleaded with him to try antibiotics as they had just been to a high Lyme disease area. He obliged me and was improving but in the meantime seeing the ALS “specialists”, who discouraged him (and his wife) from continuing on with foolishness. Sadly, after stopping his antibiotic treatment, he rapidly decline. Passing away 2years later. If even 10% of ALS patients have been misdiagnosed, we’ll, in my opinion, that is huge! Thank you so much for sharing this information!


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