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Chronic Lyme Disease Presenting with Gastroparesis: A Rare Case Study

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by

Vishnu
in

Introduction

Chronic Lyme disease, caused by the Borrelia burgdorferi bacterium, is known for its diverse and complex symptoms. While it primarily affects the musculoskeletal and nervous systems, gastrointestinal manifestations such as gastroparesis are rare. This case highlights an unusual presentation of chronic Lyme disease with severe gastroparesis that was unresponsive to standard treatments.

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Case Overview

A 54-year-old male patient presented with postprandial bloating, nausea, and weight loss persisting for two months. His history included coronary artery disease and a prior thymoma resection. Gastrointestinal scintigraphy confirmed gastroparesis, and extensive testing ruled out diabetes and paraneoplastic syndrome as potential causes.

Despite receiving prokinetic treatment, enteral feeding, and even total parenteral nutrition (TPN), the patient’s symptoms remained unresolved. Further investigations, including dark-field microscopy, revealed spirochetes and corkscrew-shaped bacteria, leading to a diagnosis of chronic Lyme disease despite negative IgM and IgG Western blot tests.

Diagnostic Challenges and Findings

  • Initial tests ruled out diabetic gastroparesis and paraneoplastic syndrome.
  • Extensive imaging, endoscopic evaluations, and antibody testing showed no definitive cause.
  • Dark-field microscopy confirmed the presence of Borrelia species, guiding the diagnosis of chronic Lyme disease.

The patient was started on a combination of ceftriaxone, doxycycline, and metronidazole, which target both spirochetes and cystic forms of Borrelia. Remarkable improvements in gastrointestinal symptoms and weight gain were noted within three months of treatment.

Broader Implications of Lyme Disease

The American College of Gastroenterology (ACG) emphasizes that gastroparesis can have multiple etiologies, including infectious agents like Lyme disease. Timely recognition of Lyme-related gastroparesis is crucial, as prolonged misdiagnosis can lead to severe nutritional deficiencies and poor quality of life.

Strategic Links for Further Reading

Conclusion

This case underscores the importance of considering chronic Lyme disease as a differential diagnosis in unexplained gastroparesis. Clinicians should remain vigilant about the limitations of standard Lyme disease testing and consider advanced diagnostic tools like dark-field microscopy when symptoms persist.

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