44. Lyme Psychosis: The only treatment is antibiotics
Session: Posters in the Park: Posters in the Park
Wednesday, October 3, 2018: 5:30 PM
Room: N Hall D Opening Reception and Posters in the Park Area
Posters
  • Lyme Psychosis.pdf (416.6 kB)
  • Background: Lyme borreliosis (LB) is a multisystem disease with cutaneous, articular, cardiac and neuropsychiatric manifestations. Multiple psychiatric disorders have been reported including cognitive disturbances, depression, panic disorder, mania, hallucinations, explosive anger, sudden mood swings, suicidality, paranoia, dissociative episodes, depersonalization, “Alice in Wonderland Syndrome, ” substance abuse, hypervigilance, low frustration tolerance, posttraumatic stress disorder, obsessive-compulsive symptoms, and catatonia. We report 3 cases of “Lyme Psychosis” that responded to LB treatment.

    Methods: We present three case reports: 1 Mania and Panic Disorder 2 Auditory Hallucinations 3 Confusion and memory loss. Prior literature on neuropsychiatric disorders were reviewed.

    Results: Case 1. 57-year-old male seen by family practitioner for a right shoulder erythema migrans (EM) rash and prescribed doxycycline. Few days later, he became agitated, attacked people and set off alarms by opening emergency exit doors.  He was brought to the hospital by police and kept on continual observation. He refused a spinal tap and intravenous (IV) treatment, but took doxycycline for three weeks with resolution.

    Case 2. 64-year-old female presented with body aches and fever. Her daughter noticed her hallucinating. She was admitted with fever, headache, photophobia and auditory hallucinations. Five providers missed an EM rash on her left shoulder. The patient recalled a tick bite a week prior to admission. She responded to ceftriaxone and was discharged  two days later on doxycycline for two weeks.

    Case 3. 77 year old female with a history of EM,  pace maker for heart block, positive western blot for LB, elevated CSF protein, recently started on iv ceftriaxone developed sudden onset of confusion and memory loss. She responded to continued ceftriaxone and completed six weeks treatment.

    Conclusion: In areas with LB recognition of Lyme Psychosis is important to prevent 1 Unnecessary psychiatric consultations 2 Inappropriate psychotropic drug therapy 3 Incorrect labelling of patients as mentally ill. All three patients responded to antibiotics.

     

    Pritiben Patel, MD1, Don Walter Kannangara, MD, MSc, PhD, DTM&H, MRCP2, Renu Toshniwal, MD3, Saman Kannangara, MD4, Dyanesh Pandya, MD3 and Manasi Revankar, DO3, (1)Family Medicine, St Lukes University Health Network-Warren Campus, Phillipsburg, NJ, (2)St Luke's Warren Hospital, Phillipsburg, NJ, (3)St Lukes University Health Network, Phillipsburg, NJ, (4)Infectious Diseases, Easton Hospital, Easton, PA

    Disclosures:

    P. Patel, None

    D. W. Kannangara, None

    R. Toshniwal, None

    S. Kannangara, None

    D. Pandya, None

    M. Revankar, None

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