Wheelchair-Bound Patient Walks Again After Lyme Disease Treatment

Severe bilateral knee pain left the patient wheelchair-bound
Lyme disease was identified alongside existing osteoarthritis
After treatment, he walked independently and avoided knee replacement

A wheelchair-bound patient regained the ability to walk independently after Lyme disease treatment. Following a 28-day course of doxycycline, his bilateral knee pain improved substantially, he returned to work, and he canceled planned bilateral knee replacement surgery.

In their case report, “Exacerbation of Osteoarthritic Joint Pain by Lyme Disease,” Bennani and colleagues describe the recovery of a 63-year-old man whose severe knee pain had left him dependent on a wheelchair.¹

The patient’s inability to walk was attributed to severe bilateral knee pain associated with existing osteoarthritis and the reported manifestation of Lyme disease in his knees. The authors did not describe paralysis.

Severe knee pain left the patient wheelchair-bound

The 63-year-old man presented to his clinician with severe pain in both knees that had progressively worsened over several months. He described persistent baseline pain that became more severe with activity.

He had previously undergone bilateral knee arthroscopies for meniscal tears and was being evaluated for bilateral knee replacement surgery. Knee radiographs showed substantial joint-space narrowing consistent with osteoarthritis.

Effusions were present in both knees. Fluid obtained from the effusions showed no organismal growth, and no crystals were identified under microscopy.

The patient had also received corticosteroid injections in both knees, but they did not provide the desired pain relief.

“Before treatment, our patient was wheelchair-bound due to the combination of existing osteoarthritis and the manifestation of Lyme disease in his knees,” the authors wrote.¹

His knee pain improved temporarily with erythromycin

The patient reported that he had recently taken erythromycin for an upper respiratory infection. Interestingly, he noticed that his knees felt better while he was taking the antibiotic.

This temporary improvement did not establish the cause of his knee pain. However, it provided another reason to investigate whether an infection might be contributing to his worsening symptoms.

Outdoor exposure raised suspicion for Lyme disease

The patient, who worked as the chief executive officer of a company, was an avid hunter. He also reported that his dog had Lyme disease.

A dog cannot directly transmit Lyme disease to its owner. However, a dog with Lyme disease can indicate the presence of infected ticks in an environment shared by the dog and owner.

Given the patient’s outdoor exposure, disabling knee symptoms, and potential exposure to infected ticks, Lyme IgG and IgM antibody studies were ordered.

Lyme disease testing was positive

The patient’s Lyme IgG and IgM antibody results were above the laboratory’s positive reference range. An immunoblot identified the IgG bands p18, p28, p39, p41, p66, and p93. A p39 IgM band was also reported.

The authors considered the six IgG bands on the immunoblot to be laboratory confirmation of Lyme disease.

Because this was a single case, it cannot determine how frequently Lyme disease worsens osteoarthritic joint pain or establish that Lyme disease was responsible for every component of this patient’s knee symptoms.

He walked again after Lyme disease treatment

The patient was treated with a 28-day course of doxycycline. After completing treatment, he reported significant improvement in his bilateral knee pain.

His recovery was substantial enough that he regained the ability to walk independently and no longer required a wheelchair. He also returned to work and reported a significant improvement in his quality of life.

The patient’s improvement led him to cancel his planned bilateral knee replacement surgery.

“Our patient was able to avoid a costly, high-risk surgical procedure with the detection and treatment of his Lyme disease,” the authors concluded.¹

Could corticosteroid injections have affected the infection?

The corticosteroid injections did not provide adequate relief for this patient. The authors speculated that corticosteroids may have reduced inflammation without treating an underlying infection and discussed possible effects on local immune responses.

However, this proposed mechanism cannot be established from a single case report. The patient also had osteoarthritis, obesity, type 2 diabetes, and other medical conditions that could have influenced his knee pain, inflammation, and mobility.

Why the patient’s recovery matters

This case highlights the importance of investigating an unexpected deterioration in mobility rather than automatically attributing all symptoms to established osteoarthritis.

The patient had clear radiographic evidence of osteoarthritis and had already been scheduled for bilateral knee replacement. Nevertheless, the substantial improvement following Lyme disease treatment suggested that osteoarthritis may not have been the only contributor to his disabling knee pain.

The authors recommended considering Lyme disease in patients with otherwise unexplained or worsening joint symptoms who live in or have traveled to endemic areas, particularly when they have outdoor exposure.

Frequently Asked Questions

Can someone walk again after Lyme disease treatment?

Mobility may improve when difficulty walking is related to a treatable manifestation of Lyme disease. In this case, a wheelchair-bound patient regained the ability to walk independently after completing a 28-day course of doxycycline. Outcomes vary depending on the cause and severity of each patient’s impairment.

Can Lyme disease affect your ability to walk?

Yes. Lyme disease may affect walking when it causes severe joint pain, arthritis, muscle weakness, balance problems, or neurologic complications. In this case, the patient became wheelchair-bound because of severe bilateral knee pain combined with existing osteoarthritis. The case report did not describe paralysis.

Can Lyme disease worsen osteoarthritis pain?

The authors reported that Lyme disease exacerbated knee pain in a patient with existing osteoarthritis. However, a single case cannot establish how frequently this occurs or prove that Lyme disease commonly worsens osteoarthritis.

Why did the patient cancel his knee replacement surgery?

After 28 days of doxycycline treatment, the patient experienced substantial improvement in his bilateral knee pain, regained the ability to walk independently, and no longer needed a wheelchair. His improvement was significant enough that he canceled his planned bilateral knee replacement surgery.

Does having a dog with Lyme disease mean the owner has Lyme disease?

No. Dogs do not directly transmit Lyme disease to people. However, a dog with Lyme disease may indicate exposure to infected ticks in an environment that the owner also visits. The owner would still require an appropriate clinical evaluation.

Clinical Takeaway

This case illustrates why Lyme disease may warrant consideration when a patient with relevant tick exposure develops unexpectedly severe or worsening large-joint symptoms, even when osteoarthritis is already present.

Positive antibody results must be interpreted within the complete clinical picture. This single case does not establish that Lyme disease commonly exacerbates osteoarthritis or that every patient with severe knee pain will experience the same response to treatment.

For this patient, identifying and treating Lyme disease was associated with markedly improved knee pain, independent walking, a return to work, and avoidance of planned bilateral knee replacement surgery.

Related Articles

Successful treatment for Lyme arthritis after knee surgery

Borrelia burgdorferi causes prosthetic joint infection

Lyme arthritis and periprosthetic joint infections

References

1. Bennani AZ, Chegwidden B, Lambroussis CG, et al. Exacerbation of osteoarthritic joint pain by Lyme disease. Cureus. 2024;16(4):e59318. doi:10.7759/cureus.59318.

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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