Lyme Disease Forces Army Officer Out of Military

Lyme disease can affect anyone who spends time outdoors, including military personnel who train in wooded or mountainous terrain. In this Inside Lyme case study, I discuss a 24-year-old Army officer whose military career ended after developing severe complications from Lyme disease.

Tick-borne infections are an occupational risk for many military personnel. Training exercises frequently occur in forested environments where Lyme disease is endemic. Weiss and colleagues described the following case in the Journal of the Pediatric Infectious Disease Society in 2017.

The young officer had recently undergone arthroscopic repair of a labral tear of the hip and was expected to return to active duty. During his recovery, however, he developed unexplained swelling in his knee.

[bctt tweet=”Lyme disease and other tick-borne infections are an occupational risk for military personnel who train in wooded environments.” username=”DrDanielCameron”]

Physicians removed approximately 75 cubic centimeters of fluid from the knee. Initially doctors suspected gonorrhea-related arthritis, but laboratory tests were negative and the swelling continued.

The officer was eventually diagnosed with Lyme disease.

Knee swelling is a common manifestation of Lyme disease. It usually results from inflammation of the synovial membrane that lines the joint. The synovial sac normally contains a thin layer of lubricating fluid that allows smooth joint movement. When inflamed, the joint may become swollen, painful, and stiff.

Inflammatory joint conditions can also occur in other areas. When inflammation affects the hip or shoulder it may be called bursitis. When it occurs where the spine meets the pelvis it may be referred to as sacroiliitis.

Discovery of Lyme Disease

The modern understanding of Lyme disease began when Polly Murray, a resident of Lyme, Connecticut, noticed unusual patterns of joint swelling among family members and neighbors. Her observations led Dr. Allen Steere at Yale School of Medicine to investigate the illness, ultimately identifying Lyme disease as a distinct condition.

Before this discovery, many individuals with joint inflammation were diagnosed with juvenile rheumatoid arthritis (JRA), even when rheumatoid tests were negative. The identification of the Lyme disease bacterium changed this understanding and allowed physicians to treat affected patients with antibiotics.

In this case, testing of the officer’s synovial fluid was positive for Borrelia burgdorferi by antibody testing and PCR. PCR testing detects bacterial DNA. Interestingly, his blood tests were negative for Lyme disease.

Persister Cells or Reinfection?

The physicians could not determine whether the infection represented reactivation of an earlier infection or a new exposure.

If the infection dated back to childhood exposure, the authors suggested the possibility of persister bacteria. Persister cells are dormant forms of bacteria capable of surviving antibiotic exposure by temporarily shutting down metabolic activity.

Persister bacteria were first described in tuberculosis. Similar mechanisms have been observed in laboratory studies of Lyme disease.

The authors speculated that surgical manipulation of the hip joint might have triggered activation of dormant B. burgdorferi.

However, reinfection while serving in the military was also considered likely, since Lyme synovitis often develops relatively early in infection.

The officer was treated with a 30-day course of doxycycline. After treatment, testing of the synovial fluid was negative for Borrelia burgdorferi.

Unfortunately, during treatment he developed swelling in his other knee.

Doctors repeatedly removed fluid from both knees over the following weeks, but the swelling persisted despite anti-inflammatory treatment.

One knee became more swollen and painful. Laboratory testing again detected Borrelia burgdorferi DNA in the synovial fluid.

The officer was then treated with one month of intravenous ceftriaxone.

Despite treatment, he remained ill with severe fatigue, headaches, memory problems, sleep disturbances, and persistent joint pain. He also developed a Baker’s cyst behind the knee.

The physicians concluded that his ongoing symptoms represented reactive arthritis and prescribed hydroxychloroquine, a medication often used to treat autoimmune conditions.

However, his symptoms continued to worsen.

Lyme Disease Ends Army Officer’s Military Career

Eventually the young officer was deemed medically unfit for continued military service.

“A medical retention decision point was reached, and he was deemed unfit for duty,” wrote Weiss and colleagues.

The loss was significant not only for the officer but also for the military. The cost of educating a cadet at the U.S. Military Academy exceeds $300,000 over four years.

Medical retirement also results in lifelong disability payments and ongoing medical coverage.

The authors concluded that this case highlights the need for increased surveillance of tick-borne infections in military training areas and earlier diagnosis and treatment of military personnel who develop symptoms consistent with Lyme disease.

Post-Treatment Lyme Disease Syndrome (PTLDS)

The authors also discussed post-treatment Lyme disease syndrome (PTLDS), a term used for patients who remain ill for six months or longer after antibiotic treatment.

These individuals often experience persistent fatigue, pain, cognitive impairment, and reduced functional ability.

Some physicians believe PTLDS represents a non-infectious syndrome. However, there is currently no reliable test that can confirm the absence of a persistent tick-borne infection.

Some patients may continue to experience symptoms consistent with persistent Lyme disease symptoms despite treatment.

Clinical Takeaway

This case illustrates how Lyme disease can lead to severe joint inflammation, persistent symptoms, and loss of occupational function—even in young and previously healthy individuals.

What Can We Learn From This Case?

1. Military personnel may face increased exposure to tick-borne infections.
2. Lyme disease can cause inflammatory joint conditions including synovitis, bursitis, and sacroiliitis.
3. Lyme disease can result in long-term disability and loss of career function.

Questions Raised by This Case

1. How frequently are military personnel and their families affected by tick-borne infections?
2. What is the best treatment approach for military personnel who remain ill after treatment?
3. How often do military service members experience treatment failure or persistent symptoms?
4. Should additional antibiotic therapy be considered in difficult cases?
5. Should physicians inform patients diagnosed with PTLDS that there is no definitive test proving the absence of persistent infection?

Treating Lyme Disease in the Military

More physicians need experience diagnosing and treating Lyme disease among military personnel and their families.

This case highlights the importance of recognizing Lyme disease in individuals who spend significant time outdoors in endemic regions.

Physicians should also have the clinical freedom to treat complex Lyme disease cases without undue interference from insurance companies, medical societies, or regulatory bodies.

---

Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.

Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention