A 32 year old woman came to see me one month ago. She was diagnosed with LD in 2003.
At that time she presented with EM rash, stiff neck, and flu like symptoms. She tested positive by ELISA and WB criteria. She was treated with 29 days of Doxycyline.
Over the last 6 years she has experienced a progressive illness. At presentation she complained of: joint pains, muscle pains, head and neck pain, memory loss, anxiety, depression, light sensitivity, and sound sensitivity. Additional symptoms included: intermittent facial rash, dizzy spells, loss of balance, profound fatigue, and irritable bowel symptoms. There was also a history of an elevated rheumatoid factor. The neurological exam was normal save sensory loss of sensation of the lower extremities. Initial Labcorp testing, done at this time showed Lyme WB positive IgM 39 and 41 bands. Her rheumatoid factor and other autoimmune parameters were normal.
She was started on therapy with Omnicef, Mincin and Plaquenil.
Four weeks later she was unexpectedly profoundly depressed. She had increased irritability with mood swings and personality changes. All antibiotics were stopped and she began psychotherapy. She deferred the use of psychotropic medications.
One month later she was feeling much better. Not exactly following my instructions, she had stopped the Minocin and Plaquenil and resumed the Omnicef as solo therapy.
Pains and fatigue were essentially gone. Her mood improved. She still had some mood swings, but the major depression was gone. Her prominent complaints were: persistent dizzy spells, night sweats, neck pain and only right hip pain. Other joint pains had vanished. She noted that bowel changes- constipation and diarrhea had abated but she had increased heartburn.
What had happened?
The patient thought the psychiatric exacerbation was due to Plaquenil. I thought not.
Brain Herx: But- she was fine on Omnicef.
Based on her symptoms it seemed likely that she had Babesia. I had not prescribed any medications that would be active against this parasite- so this shouldn't be the issue.
The question then became: Why the Minocin pych herx but no reaction to Omnicef? Omnicef attacks cell wall synthesis of spirochetes, in this case Lyme. It is relatively ineffective against Bartonella and it has no affect on intracellular L-form disease. Bartonella, according to Psych/LLMD literature is frequently associated with pyschiatric disturbances.
My hypothesis then became: Minocin killed Bartonella, perhaps in the brain leading to this peculiar reaction.
With this in mind, I decided to give all drugs with known activity against Bartonella a wide berth for the time being. These drugs do include- Minocin, Doxycyline, Zithromax, Biaxin, Cipro, Levaquin and perhaps a few others including Bactrim.
Given the night sweats and neck pain I decided to approach the suspected Babesia. My inclination was to start with low doses Artemesin while continuing the Omnicef.
The patient told me should could not afford medications that would not be covered by her insurance drug plan-
With a little more trepidation, I decided to test the waters of Babesia and prescribed a low doses of Malarone.
Another option would have been to continue Omnicef alone. My experience tells me to treat Lyme first.
Side bar: The bowel symptoms were worse but there was increased GERD- heartburn symptoms. The most likely explanation is drug induced gastric irritation of the stomach, although this is not common with Omnicef. I am becoming more convinced that Lyme frequently inhabits the GI tract and can cause symptoms there. Perhaps acid blockers which decrease stomach acidity may help kill gastric Lyme; and, regarding a somewhat related issue, it certainly appears that Asacol, a bowel anti-inflammatory, helps colon related symptoms. I prescribed Prevacid- a proton pump inhibitor which decreases stomach acidity. This should improve symptoms and perhaps aid in killing Lyme in her stomach.
Bartonella psychiatric Herx? Perhaps. We shall see.