A 58-Year-Old Man With a Diagnosis of Chronic Lyme Disease

The emergence of Lyme disease

“…In a study of such patients who then received intravenous ceftriaxone for 30 days followed by oral doxycycline for 60 days, or intravenous or oral placebo preparations for the same duration, no significant differences were found between the groups in the percentage of patients who said that their symptoms had improved, gotten worse, or stayed the same (81). Therefore, it is hypothesized that B. burgdorferi may trigger immunologic or neurohormonal processes in the brain that cause persistent pain, neurocognitive, or fatigue symptoms, despite spirochetal killing with antibiotic therapy (82). Among B. burgdorferi-infected patients, a prior history of depression or anxiety seems to be a risk factor for the development of chronic Lyme disease (83).…”

“…In those with post-Lyme disease syndrome, we follow the guidelines for treating chronic fatigue syndrome or fibromyalgia (82).…”

Lyme borreliosis in 2005, 30 years after initial observations in Lyme Connecticut

“…To explain this syndrome, it is hypothesized that B. burgdorferi may trigger immunologic or neurohormonal processes in the brain that lead to persistent pain, neurocognitive or fatigue symptoms, despite spirochetal killing with antibiotic therapy. Symptomatic therapy is recommended for such patients [76].…”

Young-Onset Dementia

“…Seizures can also occur in prion diseases, 29 neurosyphilis, 78 Behçet disease, 77 limbic encephalitis, 5-8 neurosarcoidosis, 96 celiac disease, 76 SCA-17, 68 mitochondrial disease, 90 Fahr disease, 63 porphyria, 50 neuroacanthocytosis, 64 homocystinuria, 69 Niemann Pick type C, 83 Gaucher disease, 71 cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), 113 familial British dementia, 89 metachromatic leukodystrophy, 84 Krabbe disease, 87 pigmentary orthochromatic leukodystrophy-hereditary diffuse leukoencephalopathy with spheroids, 72 Lafora body disease, 93 Kufs disease, 73 sialidosis, 92 or PLOSL. 97,98 Peripheral neuropathy can occur in the presence of DM predisposing to VaD, B12 and folate deficiencies, 114 high alcohol intake, 41 exposure to organic solvents, 42 uraemia, 115 celiac disease, 76 HIV, 116 neurosyphilis, 78 Lyme disease, 117 paraneoplastic syndrome, 6 autoimmune connective tissue disorders, primary vasculitides, 28 neurosarcoidosis, 96 neuroacanthocytosis, 64 SCA 1 and 3, 68 mitochondrial disease, 90 porphyria, 50 X-linked adrenoleukodystrophy, 85,86 metachromatic leukodystrophy, 84 Krabbe disease, 87 adult GM2 gangliosidosis, 70 adult polyglucosan body disease, 94 Fabry disease, 110 cerebrotendinous xanthomatosis, 74,75 homocystinuria, 69 and variants of hereditary sensory and autonomic neuropathy type 1 with deafness and dementia. 118 Facial weakness (Bell palsy) may suggest viral infection with herpes simple...…”