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The 71-year-old woman underwent an exhaustive evaluation to determine the cause of her abdominal pain. Tests included: CT scan of the chest and abdomen; whole body emission tomography-CT scan (PET-CT); colonoscopy; gastroscopy, and an MRI of the small intestines. Initially, doctors did not consider testing for Lyme disease as a cause of the patient’s stomach pain.
The woman was admitted to the hospital for pain management and other diagnostic workups.
READ MORE: Lyme disease manifests as abdominal pain in a young child
Approximately 8 weeks prior to her hospitalization, she experienced temporary lower back pain, myalgia, fever, burning sensations and tenderness on her head and upper legs and moderate stomach pain. Several weeks later, her abdominal pain worsened.
“Going over the history again, she emphasized that she had stayed in a high endemic area for ticks and had suffered a possible tick bite without any sign of erythema migrans,” writes Stolk and colleagues.
Lyme disease associated with stomach pain
Serologic testing and a spinal tap were consistent with Neurologic Lyme disease. The spinal tap revealed an elevated IgM antibody to Borrelia burgdorferi (Bb), a lymphocytic pleocytosis, markedly elevated IgM antibody index to Bb, and markedly elevated IgG antibody to Bb.
[bctt tweet=”Case report: When abdominal pain is the main manifestation of neuroborreliosis.” username=”DrDanielCameron”]The authors point out that “Since the incidence of LD is rising it is important to realize that severe abdominal pain could be the first clinical manifestation of early neuroborreliosis.”
After a 2-week course of intravenous ceftriaxone to treat Lyme disease, the woman’s symptoms, including stomach pain, resolved completely.
This case demonstrates the importance of re-examining a patient’s history when symptoms cannot be explained, the authors point out.
“Instead of doing extensive diagnostic tests, it is important to scrutinize the patient’s medical history in the presence of unexplained clinical signs.”
The authors note: Abdominal pain in the presence of facial paralysis has been described in Europe as Bannwarth Syndrome.
Editor’s note: I often see Lyme disease patients in my practice who present with stomach pain severe enough to warrant extensive diagnostic testing before Lyme disease is suspected.
UPDATED: May 28, 2021
Related Articles:
Long-term problems for some Lyme neuroborreliosis patients
What happens to the brain during acute Lyme neuroborreliosis?
Atypical symptoms of Lyme disease: numbness, paresthesia and abdominal wall weakness
References:
- Stolk JM, van Nieuwkoop C, van der Voorn M, van Erp S, van Burgel ND. Ticking off diagnoses of abdominal pain: early neuroborreliosis with radiculopathy. Neth J Med. 2018;76(7):336-338.
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Why do these things ALWAYS get limited to the ‘patient living in/visiting an endemic region/area’? I have had severe abdominal pain that should have been investigated as a possible tick-borne infection (because that’s what it proved to be- as treatment for said infection has alleviated a lot of pain), and yet because I have never lived in what was considered an ‘endemic region’, I was never tested until I took it upon myself to seek out testing.
There are thousands of people that live outside what is considered to be ‘endemic areas/regions’ and our symptoms and health issues are ignored, even when they match up perfectly to the symptoms of those living in endemic areas. And do NOT say the words “Lyme” or “Lyme disease” while searching for answers, as you will be completely shut out of all services like I was.
Such a sad statement about the narrow mindedness of these researchers and those that create these ‘rules’.
The most common kind of abdominal pain is a stomach- or bellyache, which happens from time to time throughout our lives. People with abdominal pain often double over, clutch their gut, feel nauseated or dizzy, and avoid food and water. The first step to addressing mild stomach pain not associated with a medical condition or trauma is to try to identify and avoid the trigger. For example, overeating or eating rich or gas-inducing food can cause heartburn, distended stomach, and abdominal pain, which can be avoided by practicing dietary changes and moderation. You can also refer to this article which states all the necessary details about abdominal-pain https://www.everydayhealth.com/abdominal-pain/guide/
I have patients who have been told that Lyme disease is not a symptoms of Lyme disease. It is common and worth further study. In some cases the stomach pain is relate to autonomic issues in Lyme disease. There are often other issues beyond the stomach that help with the diagnosis.
I am suffering with really bad stomach pain. I have chronic Lyme. I was told I have parasites as well. is Ceftriaxone well tolerated? I am just not even eating because its so uncomfortable. any thoughts? Pamela-getting desparate!!!
I find IV ceftriaxone is typically well tolerated in my patients. I start the first dose in my office in case there is an allergic reaction. I advised a low fat diet due to risk of gall bladder sludging. I am primarily concerned with risk of a central line e.g. infections an clots. I typically changed the oral medications first before IV. I also use the time on oral to rule out other illnesses.
At least this women got treated at a hospital and they found out it was nueroborreliosis. I went to the hospital twice and they did nothing but give me but say we can’t find anything answer. I was and still am in severe pain and even no spinal fluid check. I do have lyme and 3 cos.
I went yrs and yrs undiagnosed. Because of not knowing when I got bit and had no rashes. But I did have many weird ailment going on throughout the yrs. I did get medicine to treat the bandaid ailments Drs never ever checked me for Lyme. So over the yrs this infection just ballooned into this huge problem which hit me all at once and then I got the same treatment. Every kind of specialist tests came back normal. Still felt severely sick. But the Drs could’ve thought of a disease specialist 2 yrs earlier and I would’ve known what I had. I was the one who put the missing piece in in what specialist i wasn’t sent too. I had one set up at a hospital. But I needed a referral from the Dr. But the Dr had canceled it and made the app for something I had which was normal.
How frustrating.
Since my Lyme diagnosis I have had debilitating stomach pain. Lost 45 lbs, limited to ensure shakes, broth, and very, very little food outside of chicken and potatoes. I have had so many CT’s, ultrasounds, an MRI, end more blood work than I can count. The pain is crippling and every physician, specialist, etc. has given up on a possible answer. In the year and a half since my positive Lyme test I have gone from a fully functional adult to a barely functioning human and the medical community treating me as if I am crazy. I finally managed to get an appointment with an infectious disease specialist who specializes in Lyme. It’s truly my last hope. Anyone who states that Lyme isn’t real has clearly never been affected by it. PS: This is my second time with Lyme, only this time it’s actively trying to kill me.
I have often seen stomach problems from Lyme disease even if not treated with antibiotics. The stomach problems may improve if Lyme disease resolves.
I have severe debilitating back pain of the thoracic spine, unexplained weight loss and stomach issues. Could this be caused by lyme disease?
There are so many causes to consider. You would need an organized evaluation until you get an answer.
My son (13) has had intense, constant central abdominal pain for 11 months and other GI issues (diarrhea, constipation, gastroparesis, SIBO, etc.) plus terrible insomnia. His LLND and LLMD are not 100% certain that his Lyme and co-infections are the cause of this pain, or how to treat. He had a positive PCR (DNA of borrelia in the blood) on an Igenex test; AND he had 6 IND or positive bands, just not on one test: IND: 18, 31, 41 IGG (IgeneX); IND: 39, 41 IGM (IgeneX); POS: 41, 93 (LabCorp, 11/18); POS: 41, 58, 93 (LabCorp, 4/19). For Bartonella he had 1:128 on Galaxy Bartonella for IGG only, and a weak positive on Armin. (Armin did not show Lyme at all.) He also had mycoplasma. We are struggling with treatment since his gut is the main issue. We have tried oral antibiotics and IV Rocephin with no improvement at all… We’ve ruled out all other GI possibilities. Thoughts? Ideas? Help! He missed the entire school year last year and is miserable. Thank you.
It is hard to know what to do at this point without evaluating your son.
Is your son still sick? I know someone in similar situation. I am very interested in if this has improved for him over these years and what helped if so.
Can gastric ulcers be caused by Lyme? My 17 year old daughter has had lots of issues over the past few years with stomach pain being the main complaint. She has been diagnosed with PANS and a few weeks ago we got a positive Lyme test. She did not respond well to IVIG treatment for the severe PANS symptoms. IVIG seemed to make it worse. Any advice you have would be much appreciated. I hate to see my daughter suffering so badly!!
It is hard to tell if gastric ulcers are connected. I would look again at whether antibiotics might be helpful.
My daughter is 18 years old and has been sick for 8 months with severe abdominal pain, nausea/vomiting and blood in stool. She originally went to the ER and was said to have a kidney infection, a month later she had her appendix removed. She has had several ultrasounds, 2 ct scans, a colonoscopy, gastroscopy and is awaiting a cystoscopy and a MRI of the small intestine. Do you think there is any chance this could be Lyme disease. She was camping for about a month 3 weeks before she got sick and there was ticks around, although she does not remember getting a bite.
I have seen children and young adults with GI problems. The problem relates to autonomic issues when the immune system responds to the tick-borne infection.
The stomach problems clear if Lyme disease is treated. Call my office at 914 666 4665 if you have questions
Hi! I think I was bit by something while ago- I was in the deep woods doing a photography shoot with flip flops on! Dummy me- that night I came home and the top of my foot felt funny! I had no rash. 2 days later my foot swelled, I took Benadryl and it went away, 2 days after I woke up to my entire left leg tingling. My leg has felt achy ever since. My left hand feels stiff, aching in my joints as well. My left eye has been twitching and recently I’m dealing with indigestion. I have had multiple blood tests- but they still haven’t checked me for Lyme’s Disease- are these symptoms I’m experiencing? Help!
I have a few patients in my practice who have had similar presentations. I would typically include a Lyme disease evaluation.
I had a tick bite back in 2000 with bulls eye. It took me 10 yrs to find a doctor that sent my blood to Igenex on the west coast. It came back chronic by then. I was having all kind of weird symptom that i never had before yet nobody could figure it out. I ended up in a car accident about that time and hit my head on steering wheel that change my life forever. Now it is more complicated withwhat is cuncussion and what is lyme. Doctors here give the run around and i keep getting no such thing as lyme even with proof. If i hear another doctor say that i am going to lose it for sure. A naturapath in northampton mass. did the tests and gave me test results being lyme. I think i believe them more than regular doctors. This one at least takes insurance which helps but the iv’s cost thousands of dollars which i don’t have. I see that they do more intense workups than regular doctors. I try to enjoy life now at 72 the best i can but it is nowhere near my previous life. I have gone from a sumwhat inteligent person to a idiot. I even contacted the CDC and they sent me a suicide link. Believe me at times i do feel like ending it since i am so miserable. They even label me a name i can’t remember but on same idea as a hypercondriac which i don’t think i am but this is making feel like i am loosing it for sure
I have patients in my practice with similar stories despite multiple evaluations by multiple doctors. I have patients who did not know they had Lyme disease until they developed a concussion. I find oral antibiotics helpful and more affordable than IV for many of these patients.
I have Chronic Lyme over 5 years. Doctors gave me the run around and eventually I was labeled. I felt helpless as doctors in Canada don’t treat Chronic Lyme. I did lot of research on Lyme myself, and came across a women who lives in Manitoba Canada , website: Spirit of Boriel. She is the one that is helping me, when the doctors gave up on me. I am in 7month treatment, work part time, headache is gone, heart rate is better, I can move my arms and lift up to 5lb lot of improvement. My issue is Lyme weight gain as Lyme is messing with metabolic system and my stomach is bloated and sore, digestive issues. I feel this will get resolved with time also. I had to avoid any kind of sugar and carbs, take good supplements, probiotics, drink lot water, (all kind tea,) eating food on small plate, more cooked veggies trying to avoid stress, and develop positive attitude and working on spiritual, high power connection. I know this is going to be long haul.
It can be transmitted sexually they say thats why its showing up everywhere. Im currently trying to decide to get test as I heard it only tests for one strain. The Igenex tests for most all I guess. But really bad stomach pain in night and morning, joint muscle and tendon pain, weoird creaks in neck like rice krispies. Heard its in 15 percent of blood supply they found.
We still do not have a good sexually transmitted study. I have not seen a good test that is strain specific. The studies on the the blood supply have been frustrating in the absence of good testing. I advise my patients with the same presentation to add a doctor familiar with Lyme disease to their list of specialists.
My 15 yr old daughter was bitten a few years ago and I asked for antibiotics but was told no. The only symptom that she had was slight swelling in neck lymph nodes. She has slowly changed and has what appears to be gastroparesis. I now think it may be from Lyme and or co infection. She also seems to have low serotonin. The life has been sucked out of her. The 1st thing that I need is to get her tested for Lyme before she’s put on adderol which would be a band aid for 1 of her problems! What is the newest most accurate test for both Lyme AND co infections?? Thank you
It must be difficult to see your daughter ill. The tests are not as accurate as I would like. I advise my patients with similar problems to work with a doctor familiar with Lyme disease to make sure she is not ill with neuropsychiatric manifestations of Lyme disease even if the tests are negative.
Hi,
I have been treated for RA for the last 3 years. Which has only ever given me a stiff wrist.
I now have GI issues, a creaky neck and twitching muscles.
I was bitten whilst on holiday in Costa Rica but don’t know what by. This was a few months before symptoms started.
I feel like I have so many new symptoms and they do not regularly test for Lymes in the UK.
Do you think I should insist on Lymes test?
Thanks
I have included a Lyme disease test in my evaluation of patients with rheumatoid arthritis. I have had patients who had GI issues with their Lyme disease. They appear to be ill with the autonomic symptoms related to Lyme disease.
My grandson was the 17th person in Colorado to be tested and proven to have contracted Lyme disease in this state. Initially his doctors did not even suggest testing for Lym, but my NP daughter (his mother) insisted on that test being done, and it came back positive with the values indicating very recent infection.
He was treated with a short course of antibiotics after losing 40 pounds in two months due to stomach pain and other Lyme-related symptoms, and they temporarily resolved.
He is now going through a renewed period of “knife-like pain” in his stomach, and in addition has a very slightly enlarged liver, swollen lymph nodes, mid-upper-back pain, and (as of just today, prompting my online search), a severely twitching eye together with facial pain, and the manifestation of MS-like muscle effects including ‘intentional tremor’ (we have a video of him trying to lightly toss a ball to his dog, resulting in a severe contraction of his upper arm / dropping the ball). He has lost over SIXTY POUNDS in 2-1/2 months. Every time he tries to eat, he becomes nauseous, often throws up, and develops that ‘knife-like’ pain both before and even after having cut EVERYTHING out of his diet except the cans of tuna to which he has been reduced.
He has already had a PET scan, MRI scan (for the mid-back spine pain), endoscopy (which showed gastritis of unknown origin), and colonoscopy (nothing wrong). His GI doc gave up, saying it was beyond his purview, and provided a referral for him back to his infectious disease specialist — who then canceled his appointment claiming that “GI problems have nothing to do with Lyme disease.” BUNK!!
Worse, there is a WHOLESALE ABROGATION OF RESPONSIBILITY AND DIAGNOSTIC EFFORT. Neither doctor will take responsibility for referring him to some OTHER doctor who might diagnose his symptoms as anything ELSE other than Lyme, though they have no idea themselves what the underlying cause might be. Neither has opted to delve into it diagnostically with further testing to even TRY to find the problem (perhaps other known pathogens that cause severe gastritis?). He happens to be biracial, and I bristle at the fact that they have intimated that he is a drug-seeker (he’s absolutely not … he went two months without any pain meds because he REFUSED them, not wanting pain meds to deal with his deeply painful stomach problems). One even initially posited ‘cannabis-related hyperemesis’ until my daughter pointed out that his symptoms did NOT at all meet that diagnosis and that he did not excessively use/abuse our locally-legal use of cannabis, which helps him deal with the depression all this has brought upon him. He is now severely disabled by all this, with no treatment in sight.
Here in Colorado, Lyme disease-literate doctors are not to be found; are we going to have to send him to the East Coast to even get a doctor to listen to him? Are you able to refer us to a ‘Lyme-Literate doctor’ anywhere in the Denver metropolitan area? Especially one able to differentiate potential MS-related signs from ‘long Lyme disaease?’
I have patients who identified names through Global Lyme Alliance, LymeDisease.org, LymeDiseaseAssociation, and ILADS. I have patients who have used Dr. Daniel A. Kinderlehrer in your area. I am on the East Coast. Call my office at 914 666 4665 if you are on the east coast.
Feel free to message me. I’m an east coast resident (45 minutes west of Boston). My 15 year old is battling Lyme. I want to share some things with you.