Can Lyme Disease Cause Autism? What a Case Report Found

Autism spectrum disorder and tick-borne infections
One published case explored possible infectious contributors
A single case cannot establish cause and effect

Can Lyme disease cause autism? Current evidence does not support Lyme disease as a cause of autism spectrum disorder. However, published case reports have raised the possibility that tick-borne infections may contribute to neuropsychiatric symptoms in selected individuals. This article reviews one such case report and its clinical implications.

“Case report: Substantial improvement of autism spectrum disorder in a child with learning disabilities in conjunction with treatment for poly-microbial vector borne infections,” by Drs. Offutt and Breitschwerdt describes the case of an adolescent diagnosed with autism spectrum disorder who experienced cognitive and neuropsychiatric improvement during treatment directed at Lyme disease and other possible tick-borne infections.¹

The 14-year-old boy had been ill for years with fluctuating neurologic and psychiatric symptoms and had been evaluated by several physicians seeking an explanation for the changing nature of his illness.

His severe symptoms included: ADD/ADHD, tics (neck roll), anxiety, baby talk, immaturity, dysgraphia, oppositional behavior, poor reading comprehension, stammering, depression, anger, picky eating, and bed wetting.

On multiple occasions, the young man experienced behavioral outbursts that resulted in him running away from home. Over the years, he received several diagnoses, including:

• Cerebellar hypoplasia (in utero)
• ADHD (onset at age 5)
• PANS – pediatric acute-onset neuropsychiatric syndrome (onset during elementary school; officially diagnosed at age 10)
• Autism (onset during elementary school; diagnosed at age 14)
• Autoimmune encephalopathy (diagnosed at age 14)

At age 10, the Cunningham Panel™ demonstrated anti-neuronal antibodies with a borderline anti-Tubulin assay. At age 14, he was diagnosed with autoimmune encephalitis and treated with intravenous immunoglobulin (IVIG), which temporarily improved his symptoms.

“This case report provides further support to the growing body of literature indicating that infectious triggers may contribute to neuropsychiatric disorders…”

Further testing suggested exposure to Lyme disease along with evidence of other possible tick-borne infections that the treating physicians considered clinically relevant.

The patient subsequently received a variety of treatments over time, including antibiotics, dietary modifications, and supportive therapies.

“Following the introduction of a drug, most therapeutics, particularly antibiotics, were quickly discontinued due to intolerable side effects and flaring of behavioral symptoms,” wrote the authors.

Over time, the treatment regimen evolved and included several antimicrobial agents along with supportive therapies such as probiotics, antioxidants, and anti-inflammatory treatments.

According to the authors, treatment was associated with substantial improvement in several cognitive and neurobehavioral symptoms, including oppositional behavior, mood regulation, immaturity, and motor tics.

The patient experienced substantial improvement in conjunction with treatment, including marked gains in cognitive function that ultimately allowed him to attend a four-year college.

“Oppositional behavior and anger improved almost immediately after the initiation of disulfiram and these symptoms remained clear throughout the treatment period,” the authors wrote. They also noted that “squealing, grunting, grimacing, and stammering worsened when disulfiram was introduced.”

The boy’s academic testing improved from the special education level to approximately a tenth-grade level, and he no longer required the accommodations previously provided at school.

He transitioned into a regular classroom, maintained satisfactory academic performance, improved his social skills, completed a college entrance examination, and was accepted into a four-year university.

Unfortunately, attempts to discontinue antimicrobial therapy were reportedly followed by recurrence of symptoms.

“His response to this therapeutic approach included improvement or elimination of a substantial number of neuropsychiatric symptoms and significant improvement in his academic status…”

The authors acknowledged that the patient also had a well-defined embryonic abnormality diagnosed in utero. Nevertheless, they elected to pursue treatment directed toward a possible infectious trigger while considering the potential role of secondary autoimmune mechanisms.

They concluded that additional research is needed to better define the extent to which occult infections may contribute to neuropsychiatric illness and symptoms in selected patients diagnosed with autism spectrum disorder.

Important Limitations

This publication describes a single patient. Although the clinical improvement was notable, a single case report cannot establish that Lyme disease causes autism spectrum disorder or prove that antimicrobial therapy was responsible for the observed improvements.

In addition, the patient received numerous treatments over several years, including antibiotics, dietary modifications, intravenous immunoglobulin (IVIG), nutritional supplements, antioxidants, and anti-inflammatory therapies. Because multiple interventions were introduced and adjusted over time, it is impossible to determine which treatment—or combination of treatments—contributed to the clinical response.

The patient’s underlying cerebellar hypoplasia and autoimmune encephalopathy further limit the ability to attribute his clinical improvement to treatment of Lyme disease alone.

The report nevertheless highlights the importance of considering potentially treatable medical conditions in selected patients with complex neuropsychiatric symptoms, while underscoring the need for larger prospective studies.

Authors conclude:

• “We propose that a risk/benefit analysis in most patients diagnosed with autism spectrum disorder would warrant evaluation and treatment for potential chronic infectious triggers.”
• “This case report provides further support to the growing body of literature indicating that infectious triggers may contribute to neuropsychiatric disorders, including those in children who phenotypically present as academically challenged, or meet the criteria for autism spectrum disorder.”

Frequently Asked Questions

Can Lyme disease cause autism?

Current scientific evidence does not support Lyme disease as a cause of autism spectrum disorder. However, isolated case reports have suggested that some patients with autism or autism-like neuropsychiatric symptoms may also have other treatable medical conditions, including tick-borne infections. These reports cannot establish cause and effect.

Can Lyme disease cause autism-like symptoms?

Lyme disease can affect the nervous system and may be associated with cognitive changes, behavioral symptoms, anxiety, mood changes, and other neurologic manifestations. These symptoms may overlap with features seen in other neurodevelopmental or psychiatric conditions, making careful medical evaluation important.

What did this case report find?

The authors described an adolescent with autism spectrum disorder and complex neuropsychiatric symptoms who experienced substantial improvement during treatment directed at Lyme disease and other possible tick-borne infections. Because this was a single case involving multiple therapies, the findings should be interpreted cautiously.

Should every child with autism be evaluated for Lyme disease?

Routine Lyme disease testing is not recommended for every child with autism spectrum disorder. However, evaluation may be appropriate in selected patients with compatible tick exposure, fluctuating neurologic symptoms, sudden behavioral changes, or other clinical features suggesting possible tick-borne illness.

Clinical Takeaway

This case report does not establish that Lyme disease causes autism spectrum disorder. Rather, it describes one adolescent with autism and complex neuropsychiatric symptoms who experienced substantial improvement during treatment directed at Lyme disease and other possible tick-borne infections.

The report highlights the importance of considering potentially treatable medical conditions in selected patients with fluctuating neurologic or neuropsychiatric symptoms. Additional research is needed to determine which patients, if any, may benefit from evaluation for tick-borne infections.

This case highlights the need for additional research into whether infectious triggers may contribute to neuropsychiatric symptoms in carefully selected patients.

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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