Lyme disease forces 24-year-old army officer out of military

military, Lyme disease, army, tick-borne diseases

We often think of Lyme disease as a threat to the public engaging in enjoyable outdoor activities, like hiking, camping and gardening. But Lyme disease and other tick-borne illnesses are a constant threat to individuals serving in the military, who spend most of their time working in heavily forested or mountainous terrain.

 

In the case report “Latent Lyme Disease Resulting in Chronic Arthritis and Early Career Termination in a United States Army Officer,” Weiss et al. describe a 24-year-old Second Lieutenant, trained at the U.S. Military Academy, whose career was terminated due to Lyme disease. [1]

The young man had unexplained knee swelling after successfully completing hip surgery. Doctors removed 75 cubic centimeters of fluid and treated the patient for a possible Gonorrhea infection. But tests were negative and the swelling persisted.

Lyme disease tests were performed, which came back positive. The man was diagnosed with Lyme disease based on the presence of antibodies and PCR testing against B. burgdorferi in the synovial fluid.

“The patient was treated with a combination of periodic knee joint aspirations to remove swelling and a 30-day course of doxycycline,” writes Weiss. However, during treatment, the man developed swelling in his other knee.

Over the next several weeks, swelling in both knees continued, but Lyme disease tests were negative. The man was given anti-inflammatory medications and had periodic fluid removal but showed little improvement.

After a repeat test detected B. burgdorferi in the synovial fluid, the man was treated with one month of IV ceftriaxone.

However, he remained ill, developing severe fatigue, memory issues, headaches, sleep disturbances and complaints of angina. He had chronic knee and hip pain and minor effusions in both knees. A tear likely contributed to a Baker’s cyst.

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It was unclear whether the man’s symptoms were due to a Lyme disease infection 15 years earlier or whether he was re-infected. Nevertheless, he was assumed to suffer from post-treatment Lyme disease syndrome (PTLDS). No additional antibiotics were prescribed.

“Eventually, a medical retention decision point was reached, and he was deemed unfit for duty,” writes Weiss.

The economic burden to the military of losing a trained army officer was estimated to be high. “It is important to note that the average 4-year cost for educating a single U.S. Military Academy cadet is currently over $300,000,” explains Weiss.

“Moreover, medically retiring an officer results in life-long disability payments and medical coverage.”

This case “highlights the need for increased surveillance for Borrelia burgdorferi (B. burgdorferi) in military training areas and for the early and aggressive diagnosis and treatment of military personnel who present with the symptoms of acute Lyme disease,” the authors conclude.

Editor’s note: I have opposed the diagnosis of “PTLDS” until we have a reliable test to rule out a persistent infection.

References:
  1. Weiss T, Zhu P, White H, et al. Latent Lyme Disease Resulting in Chronic Arthritis and Early Career Termination in a United States Army Officer. Mil Med. 2019.
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Jason
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Jason

Also, in the original case study, not mentioned above, is the fact Soldier was treated with steroids in addition to antibiotics. The steroids are immuno-suppressive, and should never have been prescribed with a positive lyme indication. Sounds like military medical malpractice.

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Lyme disease is a continuing threat to military personnel operating in arboriferous and mountainous environments. Here we present the case of a 24-year-old Second Lieutenant, a recent graduate from the United States Military Academy, with a history of Lyme disease who developed recurrent knee effusions following surgery to correct a hip impingement. Although gonococcal arthritis was initially suspected from preliminary laboratory results, a comprehensive evaluation contradicted this diagnosis. Despite antibiotic therapy, aspiration of the effusions, and steroid treatment to control inflammation, the condition of the patient deteriorated to the point where he was found to be unfit for duty and… Read more »

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GMD

This young man’s story is so similar to so many others. Stupid and ridiculous “PTLDS” diagnosis severely hurt this young man, hurt our military, hurt taxpayers, and was totally unnecessary. Ibe month, 30 days of IV ABX is totally ridiculous. It took me almost a year to respond to 4 grams of IVABX a day. I kept taking that same treatment for well over five years. I got my life back of at least 90%. What a shame for this young man. And by the way, I finally realized I had really been suffering with Lyme disease for over 60… Read more »