This story could even be a success story.
After a shorter than average ordeal (2 months), a patient was diagnosed with neuroborreliosis and then improved with treatment.
Despite a “fresh” tick bite, IgM was negative and IgG was positive. Fortunately, this was also taken as “positive confirmation”, which of course would only be justified if the patient had not yet received Lyme treatment and did not regularly receive new bites. Most doctors would have considered this a cured case. It was very fortunate that both ELISA and Western blot confirmed the seroreaction, which had a 35-40% chance of occurring.
His medical history included double vision and glaucoma (yes, the latter is an autoimmune disease of unknown origin, in which infection and the role of borreliosis are increasingly common), paralysis of the oculomotor nerve, but what landed him in hospital was incurable headaches.
Since serology was considered a sign of possible infection, he underwent a controversially invasive spinal tap, which confirmed the presence of IgG antibodies and pleocytosis as a clear sign of infection.
The MRI scan showed narrowing of the cerebral arteries, which was assessed as a genetic variant. However, the thyroid gland also showed signs of autoimmune processes.
The bottom line is that the lady was lucky because everything matched up, so the IV ceftriaxone therapy she received brought significant improvement after a few days.
So why is Richard Horowitz, perhaps one of the longest-practising Lyme doctors in the world, so upset about this article?
- The neuropsychiatric symptoms of a seriously ill patient are not discussed
- The patient’s remaining symptoms are ignored as possible residuals, such as chronic fatigue and cognitive impairment
- The possibility of a persistent, ongoing infection is not investigated
- They do not investigate possible co-infections in central nervous system symptoms
- Treatment alternatives are not sought, as combined antibiotic treatments have already been widely reported in the literature
I would add:
- In such a textbook case, what took two months, especially with positive Lyme serology?
- Why were the MRI findings (especially the possible Bartonellosis co-infection) and the thyroid ultrasound results dismissed?
- Why is PTLDS needed to explain the symptoms after treatment, why can’t the persistence of the infection be assumed? Why do we have to wait a year to find out?
