Altered mental status due to Lyme disease
Clinicians consider Lyme disease in their differential diagnosis when an elderly man’s mental status declines suddenly, even though he had a history of dementia. The case was described in an article by Chabria et al entitled “Altered mental status, an unusual manifestation of early disseminated Lyme disease: A case report.” [1]
An 84-year-old man was admitted to the hospital due to an altered mental status. He had a history of stroke and mild to moderate dementia.
According to his wife, he had been having hallucinations 3 to 4 days prior to his hospitalization. And although he suffered from dementia, his symptoms had recently worsened.
Four weeks prior to the onset of symptoms, the man had been vacationing in Maine, a region endemic for Lyme disease.
“Oral intake had diminished considerably and he was found to have decrease in functional capacity,” Chabria wrote. Additionally, the patient was agitated, confused and at times mumbling incoherently.
He did not show any signs of an infection and his white blood cell (WBC) count and temperature were normal.
However, the man had a small bruise on his arm, which his wife attributed to an insect bite, likely a ‘black fly.’ But this could not be confirmed. Therefore, clinicians opted to treat empirically for Lyme disease.
“The presence of an atypical rash which looked more like a bruise prompted the authors to look for possible central nervous system involvement in Lyme disease,” the authors wrote.
An EEG showed diffuse slowing consistent with encephalopathy.
Test results revealed an elevated protein level, and a WBC count of 43/mm3 with 83% mono nuclear cells. Red blood cells were absent.
Based on these findings, the man was treated empirically on IV Ceftriaxone.
“This case illustrates the importance of an index of suspicion for the diagnosis of Lyme involvement of the central nervous system in a patient who at baseline had dementia.”
Testing later revealed he was positive for Lyme disease. And after several days of treatment, his mental status improved.
Related Articles:
Case review: 80-year-old with Lyme encephalopathy instead of dementia
Autopsy finds Lyme disease spirochetes in patient with Lewy body dementia
References:
- Chabria SB, Lawrason J. Altered mental status, an unusual manifestation of early disseminated Lyme disease: A case report. J Med Case Rep. 2007 Aug 9;1:62. doi: 10.1186/1752-1947-1-62. PMID: 17688693; PMCID: PMC1973078.
dr.n
09/12/2023 (11:47 am)
“Test results revealed an elevated protein level, and a WBC count of 43/mm3 with 83% mono nuclear cells. Red blood cells were absent.”
not very obvious from your post this is the results of a lumbar puncture, which is quite abnormal
Dr. Daniel Cameron
09/12/2023 (4:24 pm)
There are doctors still arguing over what the criteria is for neurologic Lyme. The authors treated based on clinical judgement.
Carl Tuttle
09/05/2023 (8:19 am)
How prevalent is untreated Lyme in neurological degenerative conditions of unknown etiology? This patient was extremely fortunate to have a medical team considering Lyme while treating empirically… definitely an exception to the plague of ignorance.
Peggy Furey
09/05/2023 (10:53 am)
So true.
Dr. Daniel Cameron
09/12/2023 (7:22 am)
I was also impressed as I wrote my blog.
Sheila Lang
11/03/2023 (1:11 am)
Dr. Cameron, can you please tell me what my results mean? Is the lyme gone? are these just memory cells? this is after two years of aggressive treating
Dr. Daniel Cameron
11/03/2023 (10:01 am)
I cannot make a diagnosis without an clinical evaluation. Lyme antibodies often persist even if the tick borne infection has cleared.