Lyme disease with seizure and pneumonia.

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.