Setare Eslami
Lyme disease is a tick-borne spirochete illness with multi systemic involvement. Al- though its neurological manifestations are becoming increasingly well recognized, its psychiatric presentations are not well known. Physicians who treat patients with lyme disease need to be aware of its neuropsychiatric symptoms, which may emerge months to years after the initial infection. Prompt diagnosis and effective treatment are needed to avoid the debilitating and possibly irreversible mental illness associated with the neuropsychiatric involvement of the disease. It has been reported that the areas of the United States with the highest prevalence of lyme disease also have the highest rate of schizophrenia. We report a case of a 63-year-old male with psychiatric history of distorted thought content, detachment from reality and somatic delusions. He reported delusions of being poisoned seven years ago which caused damage to all his body with residual poison in the fat cells despite self treating with various antioxidants, multivitamins and over the counter hepatic cleansers. Patient had history of be- ing seen by multiple specialties including cardiologist, orthopedic surgeon, infectious disease specialist, pain specialist and different internists believing they are not able to understand the effects of poison on his body. During psychiatric evaluation the patient exhibited personality changes, disinhibited behavior and mild memory impairment. In spite of acceptable scores on mini mental status exam and Montreal cognitive assessment, patient scored borderline on Frontal lobe battery assessment. Thorough medical work up was completed and he was found to have hyperintensity in frontal lobe on brain MRI. Spinal tap was done which was within normal limit. Complete Serology testing was remarkable for lyme antibody IgG. He was started on a course of doxycycline and following completion of antibiotic therapy the patient showed significant improvement in his delusions.
