Chronic Lyme patient treated successfully with low dose Flagyl

In their article “Patient with Chronic Lyme Disease and Recurrent Relapses, Maintained in Complete Remission by Low Doses of Metronidazole,” Lacout and colleagues describe a unique case of a Lyme disease patient, residing in France, whose chronic symptoms and relapses resolved with long-term, low dose Flagyl. [1]

A 55-year-old man developed numbness and burning in his legs, numbness in his hands, tinnitus, extreme weakness, intense pain, cramps at night and at rest, palpitations, paresthesias (pins and needles sensation), headaches, shortness of breath and orthostatic hypotension.

In addition, “Fatigue was intense and incapacitating, accompanied by anxiety, difficulty concentrating, mental fogginess and sleep disturbances,” the authors state.

He reported having been bitten by a tick years earlier but did not recall having a rash.

The man had been prescribed antibiotics for biliary pancreatitis but realized that his Lyme symptoms improved dramatically with the antibiotics.

Various tests including MRI, CT scan, x-rays and blood work were all normal.

A neurologist finally diagnosed the patient with diabetic neuropathy and prescribed analgesics and duloxetine. However, after several months of treatment, the pain intensified. Increased doses of duloxetine did not alleviate his symptoms.

An ENT doctor concluded that there was a link between tinnitus and the neuropathy.

He then developed urinary and erectile dysfunction, for which a urologist concluded that neurological damage was the cause of the symptoms, the authors state.

The man was eventually diagnosed by clinicians in France with polymorphic persistent syndrome after a possible tick bite (SPPT), a condition similar to post-treatment Lyme disease.

He was subsequently treated with multiple medications including: pyrantel, doxycycline, hydroxychloroquine (Plaquenil), ceftriaxone and metronidazole.

“At the end of this treatment, all signs had disappeared except for some residual intermittent leg pain.”

Unfortunately, the patient developed lung cancer and was treated with chemotherapy.

After he completed his cancer treatments, the man’s Lyme-related symptoms re-emerged and he developed relapses every 2 to 3 months.

Each relapse was treated successfully with antibiotics, typically doxycycline or azithromycin, sometimes combined with low doses of hydroxychloroquine.

“In view of these recurrent and seemingly inescapable recurrences, long-term treatment was initiated in the hope of maintaining a prolonged remission with the minimum antibiotic as possible: metronidazole 500 mg once a week,” the authors state.

In the present case, prolonged clinical remission was achieved with very low doses of Flagyl (metronidazole) 500 mg once a week.

For the past year, the patient has been in complete remission with no symptoms.

Authors Highlights:

• “In our case, long-term, inexpensive treatment with minimal doses of antibiotics (500 mg metronidazole per week) was successfully introduced: the patient has not relapsed since then, leads a normal life and has even returned to work.”
• “This case perfectly illustrates the existence of a chronic form of Lyme disease, as the patient relapsed numerous times (every two to three months for several years), and always went into remission after reintroducing antibiotics.”