Acute abdominal pain caused by neuroborreliosis
BACKGROUND: Lyme disease is a multisystem disease which can present itself in several ways. When the nervous system is involved, it is called Lyme neuroborreliosis. Both central and peripheral nervous systems can be affected.
CASE DESCRIPTION: A 39-year-old man visited the emergency department multiple times with severe abdominal-pain attacks with motoric unrest. Extensive diagnostic work-up was done, which was initially inconclusive. Lyme neuroborreliosis was suspected when he developed a facial-nerve palsy during admission; the abdominal pain was thought to be caused by thoracic radiculoneuropathy. Serologic testing for antibodies against Borrelia burgdorferi was positive, confirming the diagnosis. The patient was treated with intravenous ceftriaxone.
CONCLUSION: This case shows abdominal pain being caused by radiculoneuropathy at thoracic level, an uncommon presentation of Lyme neuroborreliosis. Often, this diagnosis is only made when neurological paralysis occurs. Information regarding skin lesions or a recent tick bite can lead to earlier recognition of the diagnosis.
Key statement: “Often this diagnosis is only made when neurological paralysis occurs.”
How often does that happen?
So all the other sorry suckers who don’t get neurological paralysis won’t be diagnosed. See why they call this “uncommon” or “rare?”
Until clinicians learn and study the widely variable symptoms and pretty much keep Lyme/MSIDS in the back of their minds at all times, it’s Russian Roulette out here regarding diagnosis. You may win or you may get the bullet.
I wish I could even count the Lyme/MSIDS patients with “severe abdominal-pain” and “unrest!” Let’s just say there’s a lot of them!
Radiculonerophathy is when Lyme (borrelia) infects a spinal nerve root and in this patient’s case it was in the thoracic region which gave him abdominal pain. It all depends upon what nerves are affected. It could be anywhere. Extrapolate this throughout the entire spine and you begin to see why thousands of patients are slipping through the cracks.
Under “Neurologic involvement,” https://emedicine.medscape.com/article/330178-clinical “Acute radiculoneuritis is reported in 50-85% of cases. Acute onset of motor deficits, severe radicular pain, and sensory loss are commonly seen after 2-4 weeks of infection. Multifocal asymmetric weakness is a common presentation. Although the presentation of inflammatory radiculoneuropathy is often indistinguishable from that of spinal-root compression, involvement of multiple dermatomes in the thorax and a lack of a precipitating injury can aid in diagnosis.”
I don’t think 50-80% of cases is rare, do you?
BTW: please keep in mind a person can jump throughout the 3 stages of Lyme at at time. So this idea you have to be infected for weeks to have radiculoneuritis is asinine an unscientific. Quit saying it.
To understand the Lyme (borrelia) organism better: https://madisonarealymesupportgroup.com/2016/02/13/lyme-disease-treatment/