Kidney Failure in Lyme Disease: A Rare Case Report

Kidney failure associated with Lyme disease is uncommon but has been reported in the medical literature. This case highlights how ignoring an early rash may lead to serious complications when Lyme disease spreads throughout the body.

Hello, and welcome to another Inside Lyme Podcast. I am your host Dr. Daniel Cameron. In this episode, I discuss the case of a 66-year-old woman who ignored a bull’s-eye rash — a classic sign of Lyme disease — and later developed acute renal failure.

Mishra and colleagues described this case,
“Disseminated Erythema Migrans,”
in the American Journal of Medicine. [1]

Case Report: Kidney Failure and Disseminated Lyme Disease

Over a two-week period, a 66-year-old woman with a history of obesity, hypertension, and hyperlipidemia developed fever and malaise.

One month earlier, she had a tick bite on her right groin. “A few days later she noticed a bull’s-eye lesion over the same area which she ignored,” the authors explain.

READ MORE:

Doctors recognize Lyme disease in a patient with kidney disease

I can’t tell you how many patients in my practice ignore the importance of a tick bite or rash.

The woman later developed clear findings of disseminated Lyme disease. She had “high-grade intermittent fever, malaise, and fatigability,” along with “multiple painless red skin lesions involving her arms, legs, and lower back,” the authors report.

Early disseminated Lyme disease typically occurs weeks after a tick bite, when the infection has spread throughout the body.

Acute Renal Failure in Lyme Disease

The patient was hospitalized and found to have unexplained acute renal failure with a creatinine level of 4.49 mg/dl. Normal creatinine levels are typically near 1 mg/dl. Dialysis is often considered if creatinine levels remain above 5 mg/dl.

Her IgM Western blot test was positive, which is expected in early Lyme disease.

She was treated with intravenous ceftriaxone and oral doxycycline. According to the authors, “Her renal functions improved following hydration, antibiotics, and discontinuation of her losartan and non-steroidal anti-inflammatory drugs.”

Although kidney failure appears to be a rare complication of Lyme disease in humans, this case illustrates how disseminated infection can affect multiple organ systems. In my own clinical practice, I have not commonly encountered kidney failure associated with Lyme disease, but case reports such as this highlight the importance of recognizing early warning signs.

Questions Addressed in This Podcast

1. What is the importance of the rash in this case?
2. When does an erythema migrans rash typically appear?
3. If a rash fades after a few days, does Lyme disease remain a concern?
4. This patient had multiple disseminated rashes. How common is this and what does it indicate?
5. Does a rash always appear at the site of the tick bite?
6. What is the risk of Lyme disease from a tick bite?
7. What is the risk once a rash is identified?
8. How often do treatment delays occur even when a rash is present?
9. What types of treatment delays have been reported?
10. What are the consequences of delayed treatment?
11. Have cases of kidney failure associated with Lyme disease been reported?
12. Could this patient’s hospitalization have been prevented?
13. Have similar complications been observed in dogs with Lyme disease?
14. Was the treatment appropriate in this case?
15. What lessons can clinicians learn from this case?

Thanks for listening to another Inside Lyme Podcast. You can read more about these cases in the show notes and on my website at DanielCameronMD.com.

As always, your likes, comments, reviews, and shares help spread awareness about Lyme disease.

Until next time on Inside Lyme.

Please remember that the advice given is general and not intended as specific medical advice for any individual patient. If you require specific guidance, please consult an experienced healthcare professional.

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Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.

Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention