Devastating Neurological Injury as a Result of Treatment of “Chronic Lyme Disease”

Frankl, Sarah; Hadar, Peter N.; Yakhkind, Aleksandra; Lang, Adam Edward; Sandsmark, Danielle K.

doi:10.1016/j.mayocp.2021.05.011

Cited by 10 publications

(8 citation statements)

References 5 publications

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“…One rare side effect is optic neuritis [ 184 , 185 , 186 ], which is dose-related [ 184 ] and may resolve slowly over many months or be irreversible [ 186 ]. Disulfiram has also been associated with rare cases of fulminant encephalopathy and CNS abnormalities upon MRI [ 8 , 187 ]; both of these cases led to hospitalization and death from complications shortly thereafter. In one of these cases [ 187 ], the individual may have been taking higher than the prescribed disulfiram dose of 375 mg/day.…”

Section: Resultsmentioning

confidence: 99%

“…Disulfiram has also been associated with rare cases of fulminant encephalopathy and CNS abnormalities upon MRI [ 8 , 187 ]; both of these cases led to hospitalization and death from complications shortly thereafter. In one of these cases [ 187 ], the individual may have been taking higher than the prescribed disulfiram dose of 375 mg/day. In the second case, the individual had been given an extremely high dose of disulfiram (one gram subcutaneously) [ 8 ].…”

Section: Resultsmentioning

confidence: 99%

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Disulfiram: Mechanisms, Applications, and Challenges

et al. 2023

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Background: Since disulfiram’s discovery in the 1940s and its FDA approval for alcohol use disorder, other indications have been investigated. This review describes potential clinical applications, associated risks, and challenges. Methods: For this narrative review, a PubMed search was conducted for articles addressing in vivo studies of disulfiram with an emphasis on drug repurposing for the treatment of human diseases. The key search terms were “disulfiram” and “Antabuse”. Animal studies and in vitro studies highlighting important mechanisms and safety issues were also included. Results: In total, 196 sources addressing our research focus spanning 1948–2022 were selected for inclusion. In addition to alcohol use disorder, emerging data support a potential role for disulfiram in the treatment of other addictions (e.g., cocaine), infections (e.g., bacteria such as Staphylococcus aureus and Borrelia burgdorferi, viruses, parasites), inflammatory conditions, neurological diseases, and cancers. The side effects range from minor to life-threatening, with lower doses conveying less risk. Caution in human use is needed due to the considerable inter-subject variability in disulfiram pharmacokinetics. Conclusions: While disulfiram has promise as a “repurposed” agent in human disease, its risk profile is of concern. Animal studies and well-controlled clinical trials are needed to assess its safety and efficacy for non-alcohol-related indications.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Disulfiram: Mechanisms, Applications, and Challenges

et al. 2023

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“…Besides this lack of efficacy, several case reports indicate severe and potentially fatal consequences of extended antibiotic treatment in the context of Lyme disease [3,23]. Therefore extended lengths of antibiotic treatment exceeding 3 weeks should not be conducted in patients with early LNB.…”

Section: Discussionmentioning

confidence: 99%

“…However, evidence gaps were identified especially regarding length of antibiotic treatment for LNB. Despite reports of considerable risks and evidence against extended treatment for symptoms attributed to Lyme disease, extended antibiotic treatment is still a matter of debate in clinical practice [2–4].…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of pharmacological treatments for Lyme neuroborreliosis: An updated systematic review

Dersch¹,

Rauer

2023

Euro J of Neurology

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BackgroundEvidence‐based recommendations for treatment of Lyme neuroborreliosis (LNB) should rely on the available literature. As new data emerges, close review and evaluation of the recent literature is needed to build evidence‐based recommendations to inform clinical practice and management of LNB. We performed an update of a previous systematic review on treatment of LNB.MethodsA systematic literature search of Medline and CENTRAL was performed for published studies from 2015‐2023 to update a previous systematic review. Randomized controlled trials (RCTs) and non‐randomized studies (NRS) were evaluated. Risk of bias was assessed using the Cochrane risk of bias tools for RCTs, NRS were assessed using the ROBINS‐I‐tool. Quality of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Data was integrated in existing meta‐analysis of the available literature.ResultsAfter screening 1530 records, 2 RCTs and 5 NRS with new and relevant data were additionally identified. Meta‐analysis showed no statistically significant difference between doxycycline and beta‐lactam antibiotics regarding residual neurological symptoms after 12 months. Meta‐analysis showed no benefit of extended antibiotic treatment of LNB. Three NRS show no benefit for additional steroid use in LNB with facial palsy.DiscussionAdditional incorporated recent research corroborates existing guideline recommendations for treatment of LNB. New RCTs add to the certainty of previous analysis showing similar efficacy for doxycycline and beta‐lactam antibiotics in LNB. Available evidence shows no benefit for extended antibiotic treatment in LNB. NRS do not suggest a role for steroids in facial palsy due to LNB.

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“…Patients with Lyme neuroborreliosis have demonstrated cranial neuropathy, lymphocytic pleocytosis, and radiculopathy, a triad that has been identified as Bannwarth syndrome [ 6 ]. A previous case report demonstrated neurological changes, presumably from chronic Lyme disease treatment [ 7 ]. Antibodies for Lyme can take weeks to develop and can remain for years after active infection is gone [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Dilemma in a Case of Lyme Borreliosis Presenting as Severe Anion Gap Metabolic Acidosis: A Case Report

Wallace,

Cullison,

Bowdon

et al. 2023

Am J Case Rep

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Patient: Male, 72-year-old Final Diagnosis: Anion gap metabolic acidosis • Lyme disease • metabolic acidosis Symptoms: Altered mental status • metabolic acidosis • unresponsiveness Clinical Procedure: — Specialty: Critical Care Medicine • Infectious Diseases • Neurology Objective: Unusual clinical course Background: Lyme disease is a common tickborne disease with a common presentation. Untreated Lyme disease can affect other organs. This can lead to anion gap metabolic acidosis through severe renal failure. Unlike anion gap metabolic acidosis, osmolar gap can be caused by ingestion of ethanol, toxic alcohols, solvents, and salicylates. Therefore, a presentation with osmolar gap and anion gap metabolic acidosis yields a variety of differential diagnoses. Case Report: A 72-year-old man presented after being found down. There were few historical cues, and workup was negative for seizures or any acute cerebrovascular incident. Laboratory results were revealing of severe anion gap acidosis with osmolar gap. During clinical decision making and diagnostic dilemma, toxidrome syndromes for potential ingestions and inhalations were sought in addition to thorough workup, which expanded to include infectious etiologies. This patient’s presentation was unique: Lyme disease in the setting of severe anion gap metabolic acidosis with an osmolar gap. Conclusions: The outcome of critically ill patients can be determined by the clinician’s method to address the diagnostic dilemma and quality of supportive care. Critically ill patient outcomes can be subject to the clinician’s method to address a diagnostic quandary. This unique case poses an important reminder for clinicians to maintain their standard methodologies of critical thinking amidst the noise of distracting medical information.

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Devastating Neurological Injury as a Result of Treatment of “Chronic Lyme Disease”

Cited by 10 publications

References 5 publications

Disulfiram: Mechanisms, Applications, and Challenges

Disulfiram: Mechanisms, Applications, and Challenges

Efficacy and safety of pharmacological treatments for Lyme neuroborreliosis: An updated systematic review

Diagnostic Dilemma in a Case of Lyme Borreliosis Presenting as Severe Anion Gap Metabolic Acidosis: A Case Report

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