Lyme disease causes mix of symptoms, including autonomic dysfunction

In the case report “A Patient with SIADH, Urinary Retention, Constipation, and Bell's Palsy following a Tick Bite,” Leone and colleagues describe a patient who developed an unusual combination of Lyme disease symptoms, all of which resolved following treatment. [1]

“Our case emphasizes that Lyme disease is capable of causing a mix of symptoms, which may be difficult to interpret, leading to a delay in diagnosis,” the authors write. And these symptoms may “develop consecutively further obscuring the clinical picture.”

A 69-year-old male presented to the hospital with abdominal pain and hyponatremia, a condition that occurs when the level of sodium in the blood is too low.

Four weeks earlier the man noticed a rash on his elbow, which resolved after one week. He also developed a decreased appetite, anorexia, abdominal fullness, chills, headache, fatigue, and myalgias and complained of having an acute onset of constipation.

“There should be a high alert of atypical presentation of this common tick bite associated infection,” the authors write.

Testing for Lyme disease was positive, and the patient began treatment with IV ceftriaxone.

Several days later, he developed Bell’s palsy, along with urinary retention, which required catheterization.

“Our case highlights the importance of including neurological Lyme disease as a possible diagnosis in individuals who present with symptoms of autonomic dysregulation….”

Two days after antibiotic treatment was initiated, the patient developed symptoms believed to be due to a Herxheimer reaction. The authors write, “the patient was found to be tachycardic, weak, diaphoretic, and febrile.”

Test results “suggested that Lyme carditis and NSTEMI were unlikely, and that these symptoms could be a Jarisch–Herxheimer reaction.” He was then switched to IV doxycycline.

At his 3-month follow-up appointment, the man’s symptoms had resolved completely.

“In our patient, an extremely rare mix of symptoms including SIADH, urinary retention, and constipation together with facial neuritis was observed.”

SIADH also known as syndrome of inappropriate antidiuretic hormone secretion is a condition in which high levels of a hormone cause the body to retain water.

Authors conclude: 

“Our case highlights the importance of including neurological Lyme disease as a possible diagnosis in individuals who present with symptoms of autonomic dysregulation such as hyponatremia due to an SIADH-like syndrome, urinary retention, anorexia, constipation, and facial palsy.”