ALS or Lyme Disease? Case of a 63-Year-Old Man
Hello, and welcome to another Inside Lyme Podcast. I am your host Dr. Daniel Cameron. In this episode, I discuss a case report involving a 63-year-old man whose progressive neurologic symptoms raised an important diagnostic question: ALS or Lyme disease?
Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease, is a progressive motor neuron disorder that leads to muscle weakness and loss of motor function.
In this case report, the patient experienced rapid neurologic decline.
“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,” the authors wrote. “By August 2018, the patient was severely impaired in everyday life activities.”
I first read about this case by Wirsching and colleagues in the journal Clinical Case Reports.
Evaluation for Lyme Neuroborreliosis
Because Lyme disease can affect the nervous system, physicians evaluated the patient for possible Lyme neuroborreliosis.
His spinal fluid test was positive for Lyme disease and showed an elevated white blood cell count. Laboratory tests also supported possible Lyme infection.
Doctors treated the patient with a three-week course of intravenous antibiotics.
Final Diagnosis: ALS
Despite treatment, the patient’s neurologic condition did not improve.
After further evaluation, the authors concluded that the patient’s illness was more consistent with Amyotrophic Lateral Sclerosis rather than Lyme disease.
The case illustrates how neurologic Lyme disease can sometimes resemble other serious neurologic disorders.
Why the Differential Diagnosis Matters
According to the authors, physicians must carefully evaluate patients with progressive neurologic symptoms.
“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.
Clinical Insight
In my clinical experience, neurologic Lyme disease can present with a wide range of symptoms that may resemble other neurologic disorders. Because some of these conditions are treatable, Lyme disease should be considered when patients develop unexplained neurologic symptoms—particularly in areas where tick exposure is common.
Careful clinical evaluation and appropriate laboratory testing are essential to distinguish Lyme neuroborreliosis from other neurologic diseases.
References
- Wirsching I, Ort N, Uceyler N. ALS or ALS mimic by neuroborreliosis – A case report. Clinical Case Reports. 2020;8(1):86-91.
Editor’s note: You can hear more about these cases through my blogs, social media, and YouTube channel.
Dr. Cameron is a Lyme disease expert and author of Inside Lyme: An Expert’s Guide to the Science of Lyme Disease. He has treated adolescents and adults with tick-borne diseases for more than 30 years.
Please remember that the advice given is general and not intended as specific medical advice for any individual patient.
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
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