Thursday, December 18, 2008
Neuroborreliosis: another case
Reader seem to like case summaries. Here is one I saw today. This 58 year old man first presented to me 13 months ago. He had typical disseminated Lyme disease with neurborreliosis. He had a normal SPECT scan but the brain MR showed white matter disease. The radiology report indicated that the findings were characteristic of Lyme disease. Western Blots were IgG and IgM positive across the board. The C6 peptide antibody test was off the charts. Oral medications over a 7 month period of time produced up and down results with a positive trend. Persistent symptoms nonetheless included: joint pains, brain fog, memory loss, muscle weakness causing him to drop things, cognitive processing delays and even bouts of confusion, headache, dysphagia (trouble swallowing), poor stamina and other symptoms. IV Rocephin was started 5 months ago. At that point his work performance was poor and he was considering disability. He started getting better, slowly at first. Ups and downs with some disorientation marked the first month. After 8 weeks, his insurance cut him off Rocephin despite extensive documentation provided by me. The patient was determined to continue therapy and payed for treatment out of pocket. After 10 weeks, Levaquin was added. He continued to show improvement. He then reported one very good day! After 14 months Flagyl 500mg per day was added. Five weeks ago he reported two fantastic weeks. He was on Rocephin 2gm daily, Levaquin 500mg daily and Flagyl 500mg daily. The Flagyl was increased to 500mg twice daily. I saw him today after more than one year of therapy. He had been on Rocephin for 5 months. He now reported 5 consecutive fantastic weeks. This man who had seriously considered disability was 100% better. Gone were multiple cognitive complaints, pains, neuropathy, weakness decreased stamina and all the other symptoms noted above. He was back- in full clinical remission. Today we stopped the Rocephin and substituted Omnicef, 600mg per day. Follow up in 8 weeks.