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Delayed diagnosis of neuroborreliosis presenting as bell palsy and meningitis

Irving Shelby Smith1, David P Rechlin

  • 1department of internal medicine at Sharon Hospital in Sharon, Connecticut, USA. imdocsmith@yahoo.com

The Journal of the American Osteopathic Association
|September 1, 2010
PubMed

Insights

Lyme disease can present with diverse symptoms, complicating diagnosis. This case highlights neuroborreliosis mimicking other conditions, emphasizing the need for timely identification and treatment.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Public Health

Background:

  • Lyme disease is a tick-borne illness prevalent in the northeastern and midwestern US.
  • Early symptoms can be mild, but late-stage infection may lead to chronic neurological issues.
  • Diagnostic challenges arise due to varied presentations, particularly without the characteristic rash.

Observation:

  • A patient presented with severe vertigo and vomiting, followed by fever, headache, and facial droop.
  • The initial presentation did not include the classic erythema migrans rash.
  • The patient experienced over three weeks of misdiagnosis before testing positive for Lyme disease.

Findings:

  • The patient was diagnosed with neuroborreliosis, a neurological complication of Lyme disease.
  • Specific manifestations included Bell palsy and meningitis.
  • This case underscores the potential for Lyme disease to present atypically.

Implications:

  • Timely diagnosis of Lyme disease is crucial for effective management and preventing long-term complications.
  • Physicians should consider Lyme disease in patients with unexplained neurological symptoms, even without a rash.
  • Increased awareness of diverse Lyme disease presentations can improve patient outcomes and public health strategies.

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