Madison Area Lyme Support Group

In their article, “Atypical Acute Neuroborreliosis With Leg Paresis and Constipation,” Ahrend and colleagues describe a case of Lyme disease presenting with neurological and autonomic manifestations in an elderly man. [1]

An 80-year-old man, later diagnosed with Lyme disease, was admitted to the hospital with left leg paresis [muscle weakness], along with pain and sensory disturbances in his left abdomen. He also had a rash on his left lower abdomen, severe abdominal pain and constipation. The symptoms had been ongoing for 4-5 weeks.

The patient had visited three other medical centers for evaluation of his abdominal pain. However, a colonoscopy and CT scan of the abdomen did not explain the severity of the patient’s symptoms.

The rash manifest as a “patchy, pruritic redness with pustules, which was particularly prominent on the left flank and abdomen,” the authors state.

Testing for Lyme disease revealed Borrelia-specific IgM and IgG antibodies, consistent with the symptomatology of neuroborreliosis.

“Finally, a diagnosis of [Lyme disease] was made, which initially manifested itself with autonomic symptoms (constipation) and severe abdominal pain, accompanied by a skin rash” and muscle weakness in his left leg that appeared later on, the authors state.

“The patient’s constipation is likely due to the autonomic involvement of the disease.”

The rash, characterized as a flat, itchy redness with pustules, was atypical for Lyme disease, the authors point out.

“… serological tests were finally conclusive for Lyme borreliosis, so that the abdominal pain and [constipation] were evaluated as autonomic, and the leg paresis as neurological involvement of neuroborreliosis.”

The patient’s symptoms resolved completely following a 21-day course of doxycycline.

After treatment for Lyme disease, the patient’s muscle weakness disappeared, as did his intestinal symptoms. And, he was able to “resume his home exercise program within two months and since then he has been on the same physical level as before,” the authors state.