Lyme patient fails to seek treatment until illness renders him unconscious

“Despite weeks of symptoms, a patient did not seek treatment until his illness rendered him unconscious,” writes Sharma from the Department of Cardiovascular Medicine at Lahey Hospital Medical Center in Massachusetts.

The 66-year-old man became ill within a week of being bitten by a tick on the back of his neck. One month later, he collapsed and was rendered unconscious, Sharma and colleagues explain in The American Journal of Medicine.

The authors describe the case in their article “Without Further Delay: Lyme carditis.” When the man was admitted to the hospital, he reported feeling lightheaded on several occasions. “He had been experiencing intermittent malaise and chills during the 3 weeks before presentation,” writes Sharma. “And for the previous 2 days, the vision in his right eye had been cloudy.”

He did not seek treatment until after he had an episode of witnessed syncope. “He had been walking across the room toward his grandchild when he suddenly felt lightheaded and tried to hold on to the wall for support. He then passed out and fell to the floor,” according to Sharma.

[bctt tweet=”Man reluctant to seek treatment for #Lyme disease becomes unconscious and loses substantial vision in one eye. ” username=”DrDanielCameron”]

He was diagnosed with carditis and optic neuropathy. “An electrocardiogram showed a predominantly junctional escape rhythm with occasional sinus beats, left anterior fascicular block, and right bundle branch block,” writes Sharma. “Our patient’s sinus node dysfunction resolved rapidly after initiation of [4-week intravenous ceftriaxone] antibiotics.”

Unfortunately, there was only minimal improvement in the 20/100 vision in his right eye.

It is possible that the 66-year-old man might have prevented an admission, avoided intravenous ceftriaxone and saved his vision if he had sought medical treatment before being rendered unconscious.

This case reminds us of the need to look out for patients who are reluctant to seek medical care.

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References:

1. Sharma AK, Almaddah N, Chaudhry K, Ganatra S, Chaudhry GM, Silver J. Without Further Delay: Lyme Carditis. Am J Med. 2017.