Atypical symptoms of Lyme disease: numbness, paresthesia and abdominal wall weakness
Doctors are beginning to consider Lyme disease as a possible diagnosis in patients who present with unusual symptoms. This case study, published in the New England Journal of Medicine, features a patient with unique manifestations of Lyme disease. Physicians presented the case at neurology grand rounds at Massachusetts General Hospital. [1]
“A 58-year-old woman was seen in the outpatient neurology clinic of this hospital in early autumn because of hypoesthesia [numbness], paresthesia, and weakness,” writes Reda and colleagues in a paper describing atypical symptoms of Lyme disease.
Her initial symptoms began 10 weeks prior with back pain occurring between her shoulders. But the pain resolved without intervention.
Several weeks later, numbness developed in a bandlike distribution around her trunk, writes Reda from Massachusetts General Hospital and Harvard Medical School. The following week, the numbness spread, extending to her upper abdomen.
“The patient was unable to sit up from the supine position without using her arms, and she had abdominal distention,” explains Reda.
Her symptoms progressed. Paresthesia (tingling or burning sensation) developed in the third, fourth, and fifth fingers of her left hand and the fourth and fifth fingers of her right hand.
The numbness that she was experiencing extended to the genital area, causing urinary incontinence.
The woman, who lived in a wooded area of Connecticut, reported having a “small, uniformly erythematous, painless, nonpruritic rash that was consistent with the hallmark skin lesion of early Lyme disease, erythema migrans,” the authors explain.
She believed the rash, which occurred three months prior to her admittance to the hospital, was caused by an insect bite. It resolved without treatment.
Her medical history also showed hypertension, hypothyroidism, and left tibial and fibular fractures resulting from a fall, along with L4 – L5 decompression and bilateral medial facetectomy.
She also presented with diabetes with a blood glucose level of 291 mg per deciliter and a glycated hemoglobin level of 11.8% (normal less than 5.7).
There were no other identifiable causes for her symptoms, despite having an extensive evaluation.
“Her recent rash and associated risk factors for Lyme disease made Lyme radiculopathy our leading diagnosis,” the authors write.
A Lyme disease Western blot test revealed 9 out of 10 IgG bands were positive.
The woman did not need a spinal tap to confirm her Lyme disease diagnosis because, as Reda explains, “When a patient is seropositive and has a characteristic clinical syndrome for Lyme neuroborreliosis, as in this case, CSF tests for Lyme disease are unnecessary to establish a diagnosis.”
Nevertheless, a spinal tap was performed. “Direct detection of the infectious agent with CSF PCR assays is usually not possible,” the authors explain.
“CSF PCR assays for Lyme-related Borrelia are not recommended,” they state, “and a negative assay (which was present in this case) does not influence diagnostic considerations, because sensitivity of the assay is poor.”
Final diagnosis
“On the basis of the patient’s clinical features and seroreactivity, the final diagnosis was Lyme meningoradiculitis,” writes Reda.
The patient improved with a 3-week course of intravenous ceftriaxone. Although her pain diminished over the next 4 weeks, she continued to have some residual problems.
Four months after her initial treatment began, “her sensation and strength of the abdominal wall had increased such that she could contract the rectus abdominis muscles while standing,” Reda explains. “But she continued to have difficulty sitting up from the supine position.”
“The weakness of the left foot had diminished, but she still had difficulty walking on the heel,” writes Reda.
Editor’s note: It is fortunate that the doctors recognized the atypical symptoms of Lyme disease. The authors did not discuss the concerns some doctors have raised regarding a persistent infection. (There is no reliable test to rule out a persistent infection.)
Related Articles:
Neurologic Lyme disease presenting as abdominal pain in 71-year-old patient
Atypical findings in Lyme disease make diagnosing difficult
Case demonstrates importance of follow-up with Lyme disease patients
References:
- Reda HM, Harvey HB, Venna N, Branda JA. Case 34-2018: A 58-Year-Old Woman with Paresthesia and Weakness of the Left Foot and Abdominal Wall. N Engl J Med. 2018;379(19):1862-1868.
Barry
02/01/2022 (7:49 pm)
I had burning shoulders…especially around the shoulder area where I had the vaccine booster. Also a badly swollen knee, where I had reconstructive ACL surgery 20 years ago. I went to one of the leading university hospitals in the country and was diagnosed by a Rheumatologist with a garbage label of RA. More respectively, Inflammatory Arthritis with a form of Myalgia. This diagnosis was given to me before they ordered 12 vials of blood. A huge red flag, in my book. I was prescribed a lifelong treatment of a low dose chemo for the rest of my life. The side effects alone can be fatal and might be worse than the illness. Flash forward 6 weeks later to today: I got in with an infectious disease doctor who is an out of the box thinker. He looked at my knee and he wanted to know when I got bit by a tick. He also looked at all 5 version of unremarkable blood work that was taken by prior Rheumatologists and two things stuck out: elevated ANA count (which often gets confused with Lupus, RA or Hoshimotos). Infectious disease doctor ordered a proper Lyme test with Western Blot and ELISA and several bands came back for borrelia burgdefori but the CDC would not approve a positive result for Lyme. Only some markers for Lyme and test result as Indeterminate. What does that even mean!? There is hope: I am three weeks of doxycycline and the knee swelling and pain improved 4 days later. I still have several months left of antibiotics. Best advice is what some of the Doctors on this thread recommended: find an infectious disease doctor (Lyme specialist) or better yet: functional medicine to get to the why or cause before you make a garbage diagnosis that can ruin your life. Hope this helps.
Belinda Moran
12/21/2021 (7:36 pm)
Chronic Lyme, Bart, Babesia and other coinfections, finally diagnosed after getting no where and have probably had this since my teens, just turned 60. Is there any correlation with bartonella and recurrent inguinal hernias? I’ve had 2 repairs on my right side and now seems I have 1 on the left side?
Dr. Daniel Cameron
12/22/2021 (1:34 pm)
I have not seen any correlation with a tick borne illnesses and inguinal hernias. I have seen patients in my practice who realize they have Lyme disease while being evaluated for another illness.
Tina Lenox
08/04/2021 (4:49 pm)
I’ve read that the majority of Morgellons sufferers test positive for Lyme disease. Are you familiar with this? And will treatment for Lyme disease lesson the symptoms of this mysterious, unbelievable disease that only a hand full of doctors will acknowledge while the remainder of them including the CDC say it’s a mental illness and those who suffer from this horrific disease are delusional as the number of patients steadily increase all over the world except for island. Suggesting all of these patients from everywhere all over the world are some how imaging all of the same unimaginable things while suicides are prevalent and lives are consumed. A lot of which have been committed to mental hospitals or referred to psychiatrists for delusions and psychosis. While each patient either has or or will lose the quality of their life. Through isolation, loss of jobs, no infer able to work bc the disease is all consuming. It’s very common for some or all family members and friends not believing you bc a lot of it isn’t possible or has never happened to a human. Yet as alone, terrified and abandoned as they are desperately seeking help when they’re dismissed as crazy and delusional needing help in support ever, yfriends and health professionals
Geno
12/05/2021 (2:30 am)
OR…IT HAS NEVER HAPPENED TO THEM PERSONALLY. Meaning..unless it directly affects them…most people do not care. If they’ve been vaccinated… unfortunately they will find out sooner than later
Courtney
04/20/2021 (12:11 am)
My father started experiencing foot numbness and severe fatigue that no one could explain. He received the covid vaccine and the numbness moved into his legs, saddle and trunk region, and now to his hands. Severe calf cramping and he can barely walk. Pushed for a Lyme test which was positive active infection. 21 days of doxy. Question I have is will the numbness stop progressing and is this a typical presentation? Could the calf pain be bartonella? I plan on pushing for IV antibiotics
Dr. Daniel Cameron
04/20/2021 (6:40 am)
It sounds as if a tick-borne illness has not been adequately addressed. You might find working with a doctor experienced in treating chronic manifestations of Lyme disease.
Michelle Camden
11/18/2020 (10:22 pm)
Daughter permanently disabled [ 21 years from age 7 and still infected ] and looking as though son will be also. [ 20 years from age 5 ] Husband – almost died, but the doctor called him a Lyme lunatic. Me – I almost didn’t make it either. 250,00.00 given to the the medical ‘industry ‘ and counting.