In 2021 a 60-year-old man from rural NY developed a swollen knee while wintering in Florida; he was diagnosed as having “pseudogout” in his knee by a Florida rheumatologist, though the fluid taken from his joint didn’t confirm this diagnosis. He returned to NY and when his knee swelled again, he was diagnosed correctly with late-stage Lyme arthritis and treated with one month of antibiotics. Over 6 weeks his knee pain and swelling completely resolved.

Two months later a bursa pouch over his elbow swelled and without further testing, his rheumatologist told him that his Lyme disease had returned and to start 4 weeks of intravenous antibiotics. He sought my evaluation; I recommended that he have fluid removal from the bursa to be analyzed; this suggested this was not Lyme disease; it has since resolved with no further treatment and he remains well.

The Lyme Disease Expert’s Analysis:

The first rheumatologist neglected to get a travel history and didn’t even consider Lyme disease. (significant error) The second rheumatologist made a correct diagnosis and chose the appropriate treatment; however, when a new problem occurred, because of the past history of Lyme disease, an expensive and potentially harmful intravenous treatment was almost started without reinvestigating the new problem.

Outcome:

The patient has recovered and remains well.

Teaching Lesson:

In patients who have had Lyme disease, there is a temptation to blame all future illnesses on Lyme disease, rather than re-investigating them.

Patient Followup Testimonial:

“I was referred to Dr. Luger for a consultation who was described to me as a leading authority on Lyme disease. I was seen promptly and within a few minutes recognized that he is, in fact, everything my friend described him to be and much more. Not only did he spend quality, unhurried time explaining my condition leading to a course of action but he did it in the most professional, informative, and sensitive manner that anyone could hope for. His expertise and a vast amount of experience were evident in that he changed the course I was recommended which would have led to an undesirable intravenous treatment. I am thankful to Dr. Luger and know that I am in good hands as I continue to be advised by the very best.”

In August of 2021, I received an urgent call from a worried family in Asia; a 23-year-old man had visited Pennsylvania 3-4 weeks earlier where he spent several days hiking and camping in the woods. When he returned to Asia he was hospitalized after a seizure with fever, a rash, and pneumonia. In the hospital, he was diagnosed with Lyme disease and started on intravenous antibiotics to treat it.  The doctor who made the diagnosis had spent part of his medical training in the United States and had some familiarity with Lyme disease.

The Lyme Disease Expert’s Analysis:

The timing of 3-4 weeks after visiting the US was spot-on for early neurologic Lyme disease; seizures are possible but rare complications of any brain infection; however, in 39 years of practice and regular review of the Lyme disease literature, I’ve never seen of a case of pneumonia caused by Lyme disease.  I advised the caller to speak to the physician and tell him that in my opinion, I felt Lyme disease was very unlikely to be the cause of his illness and offered to speak with the physician, review his labs and photos of his rash.  I advised the family to discuss with the physician pursuing other potential causes for his illness.

Post Script:

It turned out that the patient had a seizure after moderate dehydration compounded by rapid intake of a large quantity of plain water. His sodium level was very low causing a seizure; during his seizure, he vomited, aspirated the vomitus into his lungs, and had “aspiration pneumonia”.

Outcome:

The patient made an uneventful complete recovery from his pneumonia.

Teaching Lesson:

Lyme disease does not commonly cause respiratory infections. Just because something could be Lyme disease, doesn’t make it Lyme disease.

"Providers often don't test for Lyme disease when they should and do the test when they shouldn't. This leads to both under-diagnosis of Lyme disease ( in those people who have it) and over-diagnosis of Lyme disease ( in those people who don't have it)." — Steven Luger, MD

From the medical literature - CDC, September 2021

“...Few providers correctly chose Lyme disease testing as clinically useful in the hypothetical case of a patient from a state with a high incidence of Lyme disease with an arthritic knee (36.0%) or with a new-onset atrioventricular block (39.5%), and respondents across all provider types incorrectly chose testing when not clinically indicated...”

Conclusions

“Many providers evaluate patients for tick bites and treat patients for Lyme disease, but knowledge about appropriate testing is low...”

Read More (Sage Journals):

https://journals.sagepub.com/doi/full/10.1177/0033354920973235

THE POP STAR SAYS HE'S 'GETTING THE RIGHT TREATMENT'

JORDYN TILCHEN 01/08/2020

Following an earlier report from TMZ today (January 8), Justin Bieber took to Instagram to confirm that he's been diagnosed with Lyme disease and chronic mono.

"While a lot of people kept saying Justin Bieber looks like shit, on meth, etc. they failed to realize I've been recently diagnosed with Lyme disease," Bieber wrote alongside a screenshot of TMZ's article. The pop star also opened up about having chronic mono, which impacted his "skin, brain function, energy, and overall health."

… In line with TMZ's earlier report, the "Yummy" singer shared that these diagnoses will be "explained further" in his YouTube docu-series, Justin Bieber: Seasons, which will begin streaming weekly on January 27. "You can learn all that I've been battling and OVERCOMING!!" he wrote.

Bieber's caption didn't go into detail about the contents of the series, but according to TMZ, it will dive deeper into the "scary symptoms he endured in 2019." Bieber closed out his lengthy Instagram caption by noting to his Beliebers that while Lyme — an infectious disease caused by a bacteria spread by ticks — is "so far incurable," he's been "getting the right treatment." And he also promised fans that soon he will be "back and better than ever."

https://www.mtv.com/news/3151850/justin-bieber-lyme-disease/

The Lyme Disease Expert’s Analysis:

(Disclaimer - Mr. Bieber is NOT a patient of mine and my analysis is based only on what I’ve read about the case and the opinion is mine alone, based on many years of Lyme disease practice and experience)

Lyme disease is a curable infection; I’m quite troubled that not only does Mr. Bieber apparently believe that Lyme disease is incurable, but he has now spread this misinformation to a huge number of his followers. I’m also very troubled that he may have gotten this information from an unreliable source; if it is from the internet, that is a common myth; but if it’s coming from his practitioner it suggests to me the possibility that his treatment may be coming from a person who may not be fully aware of the science behind Lyme disease patient management.

One area that may have led the diagnosis astray is the fact that patients with “mono” (as the article claims he has) often have falsely positive Lyme antibody tests.