Document Type
Abstract
Publication Date
9-10-2024
Abstract
Lyme disease (borreliosis) is caused by transmission of Borrelia burgdorferi from deer ticks in the United States. Neurological symptoms can manifest in the early disseminated stage of the disease and have the worst involvement in the late dissemination stage. Few, but important case reports exist of patients experiencing disseminated Lyme with associated Guillain-Barre Syndrome (GBS). GBS manifests as an ascending flaccid paralysis with additional sensory deficits and is characterized as an immune-mediated polyneuropathy attacking the peripheral nervous system. A college-aged, wheelchair bound, quadriplegic female presented to the clinic to establish care in October 2023. She reported being bitten by a tick in February earlier that year while attending college in the northeastern United States. This progressed to borreliosis the following month after a misdiagnosis of scabies was made. She was first hospitalized in April with worsening myalgias. A diagnosis of Lyme disease was made in May following a second hospitalization and worsening neurologic symptoms. Doxycycline and ceftriaxone were given at that time. By June, a complete paralysis was observed in the bilateral lower extremities to the legs with severe neuropathic pain. She has since seen multiple specialists in pain management, ophthalmology, rheumatology, neurology, and primary care physicians. Recent labs in September 2023 conveyed high titers of antinuclear and anti-Ro/SSA antibodies despite aggressive immunosuppressive therapy including monthly plasmapheresis, intravenous immunoglobulin, and mycophenolate mofetil. Physical therapy encompassing the past 6 months has also shown no improvement in her mobility. She has come to initiate care at our clinic and would like to attempt a new physical therapy regiment and inquire about acupuncture therapy. Symptoms currently include an ascending, chronic paralysis involving all 4 extremities, neuropathic pain with a limited response to opioids and gabapentinoids, bilateral blurring of vision, and chronic constipation. Physical exam is notable for atrophy and 0/5 strength in all extremities. This case is significant for the unusual course of borreliosis leading to GBS, its severity, unrelenting neuropathic pain, and other associated symptoms. Current studies suggest that it can take years to see an improvement in symptoms in severe manifestations of GBS with a possibility of remaining severely disabled despite appropriate treatment. Misdiagnosis of Lyme disease must be avoided and treated as early as possible to prevent rare, but potentially chronic and severely debilitating outcomes.
Recommended Citation
Cisneros, Carlos H. Jr and Almeida, Alberto E., "Chronic Guillain-Barré Syndrome from Misdiagnosed Lyme Disease" (2024). MEDI 9331 Scholarly Activities Clinical Years. 83.
https://scholarworks.utrgv.edu/som9331/83
Academic Level
medical student
Mentor/PI Department
Family Medicine