Ticks and salt: an atypical case of neuroborreliosis
Siddiqui N, St Peter DM, Marur S.
Journal of Community Hospital Internal Medicine Perspectives, 7(6):358-362.
It is well documented that central nervous system (CNS) infections may lead to syndrome of inappropriate anti-diuretic hormone secretion (SIADH), but diagnosing these can prove difficult in patients with atypical presentations. We present a case of SIADH and muscle weakness in a patient without typical signs of CNS infection who was tested and diagnosed with neuroborreliosis based largely on her likelihood of exposure. This case indicates the need for Lyme testing in patients with unexplained SIADH who live in endemic areas.
The patient was an 83-year-old female with a history of type 2 diabetes and hypertension, who presented from her primary care physician’s office when her sodium was found to be 123 mEq/L (normal range is 135-145mEq/L). Her sole symptom was proximal muscle weakness. The diagnosis of SIADH was reached based on laboratory data.
A trial of fluid restriction was initiated, but neither her sodium nor her muscle weakness improved. Lyme testing was performed as the patient lived in an endemic area and was positive. Lumbar puncture showed evidence of neurologic involvement.
After realizing the appropriate treatment for hyponatremia (low sodium) in this case, intravenous ceftriaxone was started, and patient’s sodium levels improved and muscle weakness resolved. Studies show that SIADH is associated with CNS infections, likely related to the inflammatory cascade. However, the atypical presentation of neuroborreliosis for our patient delayed the appropriate diagnosis and treatment.
Our case demonstrates the need to screen for Lyme disease in endemic areas in patients presenting with neurologic symptoms and SIADH.
Again, researchers need to be extremely cautious in reporting anything regarding tick borne illness as “rare,” or “atypical.” The truth of the matter is nobody’s keeping score. The medical profession at large has denied the connection between TBI’s and the myriad of symptoms they can mimic.
I’ve posted so many articles this year on “rare” manifestations that I’ve lost count.
One of the most experienced Lyme docs in Wisconsin states,
“Not everything is Lyme, but Lyme CAN be anything.”
Truer words were never spoken.
And, of course, there’s a whole lot more at play than Lyme. The coinfections aren’t on anyone’s radar except Lyme literate medical professionals and veterinarians. These coinfections are so wide and variable in how they present that coupled with Lyme, it’s a one, two, punch and you are out.
A lot of educating on TBI’s needs to start happening in medical schools!
For more rare manifestations: https://madisonarealymesupportgroup.com/2017/11/24/dr-frid-lyme-parkinsons-autoimmunity/
I literally could go on and on to infinity……