Conversion disorder, Guillain-Barré syndrome or neurologic Lyme disease?

The authors of “Atypical Lyme Neuroborreliosis, Guillain-Barré Syndrome or Conversion Disorder: Differential Diagnosis of Unusual Neurological Presentations” present a challenging diagnostic case involving a 62-year-old woman with symptoms consistent for multiple neurologic disorders.

Teodoro and colleagues describe the case of a woman who was initially suspected of having a conversion disorder but later diagnosed with Guillain-Barré syndrome, possibly triggered by neurologic Lyme disease. ¹

(Conversion disorder is a mental condition in which a person has blindness, paralysis, or other nervous system (neurologic) symptoms that cannot be explained by medical evaluation.)

The woman reported to the emergency room with weakness in her left hand and both of her legs, which resulted in 2 consecutive falls with head trauma. Test results were normal, and she was discharged. But the following day her symptoms worsened, and she returned to the hospital with significant motor impairment (an inability to walk independently) and urinary incontinence.

“On admission, her neurological examination revealed asymmetric tetraparesis, hyporeflexia, doubtful hemihypesthesia, and left extensor plantar reflex,” writes Teodoro and colleagues in the journal Case Reports in Neurology.

(Tetraparesis means weakness in all extremities. Hemihypesthesia is a reduction in sensitivity on one side of the body.)

Conversion Disorder

The woman was initially treated for a conversion disorder since her findings suggested this diagnosis including “the absence of a typical pattern the reference to a positive Hoover sign in one of the early evaluations, inconsistent and fluctuating motor deficits, coinciding timeline with stressful life events, and a predominantly anxious basal affective state,” writes Teodoro.

The patient reported having a recent stressful event and symptoms of anxiety.  In turn, she was prescribed the antidepressant Sertraline (100mg) and Pregabalin (150mg), a nerve pain drug, also known as Lyrica.

But by day 5, the woman’s symptoms had worsened. Her upper and lower limbs were areflexic. And, needle electromyography revealed “a subacute motor axonal neuropathy pattern and a right median nerve mononeuropathy.”

[bctt tweet=”Case report: Conversion disorder, Guillain-Barré syndrome or Lyme disease?” username=”DrDanielCameron”]

Guillain-Barré syndrome

Guillain-Barré syndrome, an autoimmune disorder, was considered based on EMG findings and a spinal tap which revealed albuminocytologic dissociation, a hallmark finding of Guillain-Barré syndrome.

A 5-day course of 32 g/day of intravenous immunoglobulin (0.4 g/kg/day) was initiated and led to a partial improvement in motor function.

Lyme disease

She was subsequently diagnosed with neurologic Lyme disease based on a positive IgM titer and a repeat spinal tap, which showed an elevated mononuclear white blood cell count of 20/μL and positive IgM.

“None of the most common infectious agents associated with Guillain-Barré syndrome were identified.  Surprisingly, serologies for Borrelia were revealed to be positive, with further finding of IgM Borrelia antibodies in CSF,” writes Teodoro.

“The possibility of a Guillain-Barré syndrome due to Borrelia infection should be considered,” the authors point out, “although this syndrome usually develops as a post-infectious syndrome.”

The woman was given a 14-day course of Ceftriaxone (2 g/day) and showed significant improvement in motor function. However, she was discharged requiring additional physical therapy and rehabilitation.

This is not the first case of a medical condition being diagnosed as a conversion disorder.  “There are case reports of Guillain-Barré syndrome misdiagnosed as a conversion disorder², highlighting the importance of considering the clinical heterogeneity of the possible presentations,” writes Teodoro.

Furthermore, although it is rare, there have been reports of neurologic Lyme disease mimicking Guillain-Barré syndrome.³

“This case highlights the importance of the differential diagnosis of atypical presentations of neurological disease, including the possibility of functional neurological symptoms,” the authors conclude.

  1. Teodoro T, Oliveira R, Afonso P. Atypical Lyme Neuroborreliosis, Guillain-Barré Syndrome or Conversion Disorder: Differential Diagnosis of Unusual Neurological Presentations. Case Rep Neurol. 2019 Apr 30;11(1):142-147.
  2. Edelsohn G. Guillain-Barré misdiagnosed as conversion disorder. Hosp Community Psychiatry. 1982 Sep;33(9):766–7.
  3. Tyagi N, Maheswaran T, Wimalaratna S. Neuroborreliosis: the Guillain-Barré mimicker. BMJ Case Rep. 2015 Jun 25;2015.pii:bcr2014209080.

7 Replies to "Conversion disorder, Guillain-Barré syndrome or neurologic Lyme disease?"

  • Danielle Gauss
    05/01/2021 (7:46 pm)

    My 17 year old daughter out of the blue began having twitches, then seizure like activity, all while conscience. As time went on she began to develop paralytic episodes triggered by light, sound, so zoom learning was very difficult for her. Sometimes her tremors and stiff episodes are so violent that she dislocates. She has moments where she stutters, collapses, is in constant pain. Cognitive skills are awful, and her memory is terrible. She has been told that she has Functional Neurological Disorder, or conversion disorder since all scans are normal. She gets bit by mosquitos and bugs constantly, and all of her symptoms started after she began working at a stable with horses. Is it possible that this could truly be Lyme disease? If so how can I help her? She is debilitated.

    • Dr. Daniel Cameron
      05/02/2021 (9:13 am)

      I have Lyme disease patients with similar presentations that were initially thought to functional AKA psychiatric. I typically recommend that my patients consult a doctor with experience treating Lyme disease.

    • Jocelyn P
      11/16/2022 (10:08 am)

      Hi there. I just stumbled across this article, my daughter presented much the same way. All tests have come back normal except she tested positive for Mono and epstein barr which would’ve been contracted 2.5 months ago. Just curious Danielle how your daughter is doing and if you guys got any answers?

  • Kristen
    04/30/2021 (1:28 pm)

    Hi my name is Kristen I had bullseye rash on skin 16 years ago. Got very sick after. Western Blot negative over and over. Had no idea about confections back then. Was hospitalized and diagnosed with trygiminal neuralgia. Suffering for years endless surgeries and radiation. Spinal tap negative. Epstein Barr showing up often.. Thousands dollars spent on treatment only to come up negative. I have severe flair ups. Excited to join this group.

    • Dr. Daniel Cameron
      04/30/2021 (3:30 pm)

      I find the tests for Lyme disease and co-infections are not all that good. Welcome to the group.

  • Beth Woods
    02/03/2020 (11:01 am)

    Very similar story to my then 16 yo daughter. But we were not given any other diagnosis or testing beyond conversion disorder. I was told repeatedly that we were too ‘enmeshed’ and that I was contributing to her CD. So very sad. She’s 26 now and I know would have been on the road to healing had we been not sent down the wrong path repeatedly for so many years.
    Listen to your gut and get another and another opinion if needed! Hard lesson to learn for us, I pray other don’t have to.

    • Dr. Daniel Cameron
      02/03/2020 (11:08 am)

      I have had Lyme patients who have gone down the conversion disorder path before being diagnosed.  I was happy that the authors described case.

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