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"

  • RyanMcerlane
    11/22/2022 (4:24 pm)

    Yep nursing homes in NSW Australia are all jabbed up for covid and shingles,and wouldn’t U know everyone’s got covid and shingles
    Problem is I’m 38 haven’t had a jab in 15 years and I have just got a raging case of shingles
    As have other purebloods in my area
    Also lots of jabbed people getting Lyme disease too
    It’s a buffet of sickness these days

  • Suzy
    07/11/2021 (8:13 am)

    About a month ago, I swept a biting bug off my lower calf area. A few days later, a red mark that looked like a burn mark appeared, followed a week later by a diffused ring with a red dot at the center. I did a test for lymes but it was negative. Over the next couple of weeks I had joint aches and a month later had uncomfortable burning under the skin on the right side, mid abdomen. It did feel similar to a mild shingles outbreak I had about 15 years ago. My doctor has left it up to me to decide if I want to do a three week course of doxycycline. At issue is a history of severe side effects of this antibiotic due diagnosed IBS.
    I’m not sure which way to go.

    • Dr. Daniel Cameron
      07/11/2021 (9:20 am)

      It can be difficult to be sure a rash is Lyme disease. The tests for Lyme disease can be negative particularly early in the illness. I take an illness after a rash serious in my patients. It sounds as if you have a doctor who is willing to treat to be on the safe side even if there are risks of stomach upset.

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