Case report: Meningitis secondary to Lyme disease


In this case report, “Meningitis in the Guise of Dementia: Lyme-Induced Normal Pressure Hydrocephalus,” Liu and colleagues review the case of an elderly patient with dementia, found to have Lyme meningitis in the setting of a normal pressure hydrocephalus (NPH). [1]

An 80-year-old man was admitted to a hospital in Pennsylvania, an area endemic for Lyme disease, due to increased weakness and confusion. He had “several days of nausea with decreased appetite, generalized malaise, fatigue, and weakness,” according to the authors.

Cerebrospinal fluid (CSF) studies suggested aseptic meningitis. And a CT scan showed dilated ventricles. Treatment for normal pressure hydrocephalus relieved his symptoms.

On the fourth day of hospitalization, the man tested positive for Lyme disease by Western blot on bands 23KD and 39KD.

“Healthcare providers treating patients with NPH should consider Lyme disease as a differential diagnosis because of the multiple reported cases of NPH secondary to Lyme disease.”

“The patient was subsequently diagnosed with aseptic meningitis secondary to Lyme,” the authors state.

He was treated with IV and oral doxycycline. But his dementia did not completely resolve, “likely due to primary dementia or other condition.”

“In the case of our patient, infectious meningitis was suspected due to this patient reportedly having had fevers and leukocytosis. Additionally, Lyme disease is among the most common reportable infections in Pennsylvania,” the authors state.

Authors Conclude:

“Lyme disease … can present with multiple complications, including arthritis, heart rhythm defects, facial nerve palsy, impaired memory, and meningitis. Hence, Lyme disease should be considered as part of the differential etiology of meningitis.”

  1. Liu R, Polly M, Lennon RP, Reedy-Cooper A. Meningitis in the Guise of Dementia: Lyme-Induced Normal Pressure Hydrocephalus. Clin Med Res. 2023 Dec;21(4):226-229. doi: 10.3121/cmr.2023.1829. PMID: 38296639.

6 Replies to "Case report: Meningitis secondary to Lyme disease"

  • Angela Berry Koch
    03/01/2024 (10:35 am)

    Aseptic meningitis implies “other than” bacterial. Bacterial culture cannot be “ standard “ as current protocol demands, since in the case of Borrelia B we know can that it can take 16 weeks to grow the spirochete with 94:/: accuracy. In endemic areas wouldn’t it be prudent to assume Lyme in such cases and treat prophylactically ?

  • Irene Sickles
    03/01/2024 (7:31 am)

    I was diagnosed with Lyme disease in July of 2022, I was very ill and had bells palsy. I was treated with doxycycline. I’ve never been completely over it. I have insomnia and stiff joints. I can’t find a Dr. That will treat me now.

    • Wendy Mergendahl
      03/01/2024 (9:16 am)

      We have had good results with herbal supplements after antibiotics. Dr. Rawls has a good program. Hanna Kroeger’s SPK has been helpful, also. Good luck.

    • Karen Beernink
      03/01/2024 (8:07 pm)

      Irene, Did you get tested for co-infections? What state are you in?

    • Mary C Piscitello
      03/02/2024 (9:35 pm)

      Find an Ilads Dr near you. I travel to VA from Hilton Head to See Gary Kaplan. I am not cured but am doing about 50% better than I was 5 years ago. It’s expensive treatments are not all covered but is worth the money if you can afford it. Maybe someday the NIH will wake up and get with the program which would increase insurance coverage.

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