Lyme disease misdiagnosed as shingles in a 62-year-old man

man with lyme disease and shingles at doctor's office

A recent article, published in the journal Clinical Case Reports, describes the case of a 62-year-old man, from Norway, who was initially diagnosed with shingles, a viral infection which produces a painful skin rash with blisters in a localized area on the body. [1] Shingles, also known as herpes zoster, is common in older individuals who have had chickenpox.

According to Hansen and colleagues, Lyme disease was misdiagnosed as shingles but later correctly diagnosed with Lyme disease.  The patient was admitted to the emergency department complaining of epigastric pain that had been ongoing for 4 to 5 weeks. “He described a constant pain with episodic worsening,” writes Hansen. The pain began with a rash in the man’s right upper quadrant area.

Physicians considered several diagnoses. The man had a history of migraines, anxiety, colon polyps, and had been treated for gastroesophageal reflux disease (GERD). Small gallbladder stones were present but were not acute.

The man was diagnosed with shingles and prescribed acyclovir and pregabalin. Despite treatment, he remained ill. His pain increased and “he developed additional symptoms including nausea, lethargy, decreased appetite, constipation, decreased size and force of the urinary stream, and a 5–7 kg weight loss,” writes Hansen.

[bctt tweet=”It wasn’t shingles, it was Lyme disease. ” username=”DrDanielCameron”]

Imaging and lab tests were negative and the man was discharged. However, one week later, he was re-admitted to the hospital because “his general practitioner did not find it reasonable that his anxiety could explain his current symptoms,” says Hansen.

The man lived in an area endemic for Lyme disease. Although he did not recall a recent tick bite, he had been bitten previously, so serologic tests for Lyme disease were performed. Because his titers of B. burgdorferi IgG were so high and he had a history of tick bites and a rash, a lumbar puncture was ordered. Results were positive.

The 62-year-old man was diagnosed with Lyme disease. His symptoms, except for fatigue, resolved after a 3-week course of IV ceftriaxone. “His weight is now normalized and he has no problems with constipation,” explains Hansen. “The abdominal pain is almost gone. His main problem is fatigue but this is gradually improving.”

The authors point out that atypical clinical presentations of Lyme disease can occur, including gastrointestinal manifestations because of autonomous dysfunction, as was seen in this case.

  1. Hansen BA, Finjord T, Bruserud O. Autonomous dysfunction in Lyme neuroborreliosis. A case report. Clin Case Rep. 2018;6(5):901-903.

26 Replies to "Lyme disease misdiagnosed as shingles in a 62-year-old man"

  • Ann Angelli
    08/16/2020 (8:06 pm)

    Diagnosed with shingles. A few days later a red area – not a rash just red. Above shingles appeared. As the red area increased in size a blueish purpleish ring developed inside the outer edge of circle. First set of lyme labs came back, inconclusive. Second set of labs came back several weeks after shingles and red went away – none shown. I did find a tick on my back. Not embedded in skin just crawling. No bite marks on back, arms, neck, legs, chest. What is your thought?

    • Dr. Daniel Cameron
      08/17/2020 (8:08 am)

      It can be a challenge to determine the cause of some rashes. I prefer to include an antiviral medication if shingles is a consideration. As many as 3 out of 4 patients with Lyme disease do not recall a tick bite. I followup my patient to look for a tick borne illness of to rule out other illnesses.

  • Ellen
    11/27/2019 (7:27 am)

    I have been treating Lyme, Bartonella, and Babesia for two years, naturopathically and with Docycycline, Azythromycin, and Flagyl, and with Chinese herbals.

    Have suspected that I have had Rabbit Fever but I’m not sure if that’s been handled. I have had Herpes II for nearly 40 years, but what I thought was a herpes break out in a new location, now appears to be Shingles.

    Question, is the standard MD treatment for shingles harmful to me or the herbal protocol used for treating the other infections along with heavy metals detox?

    Stress is also sky high: job loss and job hunting, moving in with my partner in a new state, the holiday season upon us with a complex trauma history involving, Santa-suited perpetrators.

    (What could get worse, has with this shingles.)

    • Dr. Daniel Cameron
      11/29/2019 (6:16 pm)

      My blog addressed the misdiagnosis of shingles. Your doctor will have to determine the best treatment.

      • Tracy
        08/20/2021 (9:53 pm)

        I had Lyme disease 14 years ago and treated it immediately. Never seem to have any issues after that. Now I have reoccurring shingles and was wondering if it could be from the Lyme disease. No one can really figure it out but the shingles are quiet painful. I have had shingles at least six times. Anyone else have this issue?

        • Stephanie Chick
          01/31/2022 (12:58 pm)

          Yes! I have had shingles 10 times now. I also had Lyme disease and was treated previously(about 10 years ago), but shingles began about 2 years ago. Similarly, no traditional doc(PC, Immunologist, etc.) has figured it out yet. I’m going back to my LLMD.

        • Colleen Greco
          08/21/2022 (11:07 am)

          I have read the Covid vaccines may reactivate the herpes viruses.

          • Melissa
            11/12/2022 (9:35 pm)

            I am not vaccinated to add so I don’t think that’s a factor however the virus itself might be 🤔

          • Dr. Daniel Cameron
            11/14/2022 (7:41 am)

            some people have exposure tot the varicella-zoster virus without knowing it.

          • Cathy Koval
            01/16/2023 (12:21 pm)

            Could be. If you read a fair amount about covid the genome sequencing evidently has been studied as part of determining it’s mutation from bats to human hosts and it has been highly suspicious to have been designed with a section of HIV as part of it. Some docs are saying if recurring issues you should be tested for HIV

          • Carol MacDonald
            01/14/2023 (8:04 pm)

            Wow really. Very interesting. I got shingles 16 months after second vaccine dose. Not to mention. I had added stress but very interesting. Do you know the reasoning behind this ?

          • jodie
            01/15/2023 (1:07 pm)

            My husband has a friend that got the C shot and broke out with a really bad case of shingles. It is said the shot brings out viruses and bacterial infections that lay dormant.

        • Melissa
          11/12/2022 (9:23 pm)

          Yes me too! I was diagnosed and treated for Lymes disease two years ago and now I get the shingles every other few months around my menstral cycle ! I’ve had it probably 12 times in the past two years

        • Brenda
          02/13/2023 (1:01 pm)

          Yes. My lymes has only been inactive for 17 months though. I get reoccurring shingles. I had shingles 6 times in 2022. I’ve had it once in 2023 already. My doctor said it’s because my body is still recovering from lymes. He said it won’t happen as much as time goes by and my body recovers. The fact it’s been 14 years for you is concerning. I keep antivirals on hand. The doctor wants me to take a small dose as a preventative because I get shingles in my eye but I can’t stay on them because I start reacting to the medicine.

  • Susie
    03/02/2019 (6:16 pm)

    I was diagnosed with Lymes in 2013. Initially my Dr. thought it was contact dermatitis and or costrocondritis. My symptoms were skin pain no joint pain. My skin hurt from the waist up, lost weight and fatigue before I asked my Dr to check me for Lymes.
    I recently went to see a neurologist and was diaganoised with postherpetic neuralgia. Had shingles in November and reoccurred without rash in January. just the burning sensation on my skin lasting along time. I’m a 68 yr old female.I feel my immune system has been tampered from the lymes so I am refusing the vaccine. What do you think?

    • Dr. Daniel Cameron
      03/02/2019 (8:38 pm)

      There are many factors that contribute to shingles. I am not aware whether a history of Lyme disease can increase the risk of shingles. You will have to work with your doctor on whether to take the shingles.

    • Linda Spennato
      07/25/2019 (2:29 am)

      I was diagnosed with Lyme in 2012. By 2015 I was much improved. Then, I had hip problems followed by back pain. A steroid injection helped with the hip. A few months later, I received an epidural for my low back. Days after,I had a shingles outbreak at the injection site. It was not diagnosed as shingles until 2 1/2 yrs later. I had multiple treatments, surgeries, etc… They all failed. I haven’t been able to sit or stand in place for 3 yrs now. In Dec 2018, I had a huge breakout which spread across my upper butt and jumped the line. I’ve been treating shingles with antivirals, supplements, diet, etc… It has popped out 9 times since Dec. This happens while on maintenance dose and sometimes full doses of antivirals. I often wonder if the chronic lyme has made the shingles chronic now.

      • Dr. Daniel Cameron
        07/25/2019 (11:49 pm)

        I have patients who suffer from Lyme disease and another illness at the same time.

  • Catrina Hodges
    12/11/2018 (6:04 am)

    I have had ongoing problems with my eye for 13 years. I was also diagnosed with shingles, and took 1mg of Acyclovir for years, but never got better. After many years of being misdiagnosed, undiagnosed, or accused of being delusional, I flew to VA, and was diagnosed with Chronic Lyme disease , a RMSF coinfection, and Morgellons disease. I am 47 years old, married with two children. The last 13 years of my life have (literally) been hell on earth! Because I live in GA, it is costly, and therefore causes a great financial hardship for me to fly to VA to be treated! I cannot find a Lyme literate dr in my area, and the “clinics” I have discovered use a holistic approach to this dreadful disease, AND DO NOT accept insurance. My eye, skin, and scalp are the most affected, and how it began, but I’ve developed SO many other symptoms during these years, it’s disheartening and depressing! I now have lost over 20% of my vision, joint/muscle aches, raynauds, cluster headaches, numbness and weakness in my extremities, sensitivity to all elements, brain fog, depression,’ malaise, extreme fatigue, neuralgia, and a list of othe symptoms as well. I am at the end of my rope. I am still having “flare ups”, I am still getting painful nodules on my scalp, hair loss, reoccurring fever (100 or higher), unexplained sores all over my body, hyperthyroidism, reoccurring ear aches with fluid in my ears, trouble swallowing , digestive issues, and many more symptoms. I have always exercised, I am not overweight, I quit smoking over 15 years ago, I seldom drink alcohol, and once considered myself an active, healthy, happy person. I am terrified this is going to kill me, and my family will be left without a mother and wife. I do not know where to turn, what to do, and sometimes question if I even want to continue to live with this dreadful disease,?that has basically stolen my (once happy & healthy) life. Bring a devoted Christian with a strong and everlasting faith, It’s difficult to admit this. I know my symptoms are worsening, and I feel like no one in the medical field could care less what happens to me! Mostly because almost every health care professional I’ve seen accuses me of being delusional , on drugs, inflicting myself with these symptoms or have misdiagnosed and treated me for another condition. Is there any information, insight, and/or advice you can give me to help me find a dr willing to treat my symptoms and/or at least help reduce my numerous flare ups? Thanking you in advance!
    Infected in GA

    • Dr. Daniel Cameron
      12/14/2018 (5:46 pm)

      Your comments reflect how difficult to get access to care. Keep working on getting better.

    • Carol MacDonald
      01/14/2023 (8:07 pm)

      Oh my. I’d like to speak with you. I’m having troubling nerve pain and itch several weeks later after being diagnosed and treated for shingles. Stress brought mine on . You poor thing. Geez. Doctors think we ate crazy. Ugh.

  • Cathrine Mihm
    05/25/2018 (10:41 pm)

    Yes me too but did not resolve with ceftriaxone IV….using pure stevia leaf extract and homeopathic nosode tincture. ..getting well

    • Joyce Cacchione
      11/20/2018 (6:07 pm)

      Hi Cathrine.
      Glad to see you had success with a more holistic treatment plan. Would you be willing to share a little more info about your lyme disease story. I’ve been sick for many years and rely solely on natural treatments. I am currently pulsing two sets of remedies every two weeks, both sets containing one remedy that attacks the parasites and a second remedy that breaks through the biofilm. I do whatever I can to detox including sweating, epsom salt baths and glutathione. I’m thinking of mixing things up a bit to rid my body of this horrific disease once and for all. Thanks for any info you care to share.

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