Abdominal pain, ileus and constipation due to Lyme disease

Welcome to another Inside Lyme Podcast. I am your host Dr. Daniel Cameron. In this episode, I will be discussing the case of a 65-year-old woman with abdominal pain, ileus/pseudo-obstruction and constipation due to Lyme disease.

Zulfiqar and colleagues first described this case in an article entitled “The many manifestations of a single disease: neuroborreliosis,” published in the Journal of Community Hospital Internal Medicine Perspectives.¹

A 65-year-old woman on hormonal therapy for estrogen receptor-positive breast cancer presented to the Emergency Department with sudden seventh nerve palsy, commonly referred to as Bell’s palsy.

One week prior, she began having burning back pain radiating to the abdomen, which had grown worse and over the past several months had suffered from constipation.

Stroke, herpes virus or Lyme disease?

The woman was admitted to the hospital for a suspected stroke. However, there was no evidence of a stroke by brain CT or MRI.

Doctors also suspected she had a herpes zoster infection and prescribed valacyclovir, an anti-viral medication.

The patient worked frequently in her backyard and was exposed to wooded areas. She also recalled having a rash on her stomach 11 days before being admitted to the hospital.

“Lyme serum antibody (IgG and IgM) was positive with confirmatory Western blot resulting in multiband reactivity,” the authors write. Spinal tap test results were also positive for Lyme disease.

The woman was diagnosed with neuroborreliosis, or Lyme disease and treated with oral doxycycline.

However, while hospitalized the patient developed diffuse abdominal pain, abdominal distension, and worsening constipation.

An abdominal x-ray showed mild ileus. “CT abdomen with contrast was done which suggested constipation without obstruction or ‘significant’ ileus,” the authors explain. A colonoscopy was also normal.

The woman was also diagnosed with Syndrome of Inappropriate Anti-diuretic Hormones (SIADH) based on a sodium of 129 and typical urine findings.

Abdominal pain, gastrointestinal problems in Lyme disease

The authors highlight several studies demonstrating a range of gastrointestinal problems, including abdominal pain, associated with Lyme disease.

“There have been many case reports in the past highlighting the atypical presentation of Lyme disease including, but not limited to pseudo-obstruction, constipation, back pain radiating to abdomen (radiculoneuritis) known as Bannwarth Syndrome as a manifestation of autonomic dysfunction related to neuroborreliosis,” the authors explain.

This patient also suffered from anorexia with a loss of 14 pounds. One study found that 23% of 314 patients with early Lyme disease suffered from anorexia.

Meanwhile, Shamim et al. reported two cases of patients who presented with severe constipation and hyponatremia in addition to other features of Lyme disease.

Lyme neuroborreliosis has also been reported as “the culprit of chronic intestinal pseudo-obstruction” in other studies, the authors explain. “The patients can develop worsening constipation and obstipation as diagnosis and treatment is delayed, leading to diffuse bowel dilation in the absence of mechanical obstruction.”

Lastly, “There have been a few case reports of SIADH associated with neuroborreliosis,” writes Zulfiqar.

Authors’ Conclusion: Lyme disease should be suspected in patients who are from Lyme endemic areas and present with abdominal pain, constipation and SIADH with or without cranial nerve palsy.

The following questions are addressed in this podcast episode:  

1. Why was a stroke initially considered?
2. Why was herpes zoster suspected?
3. What are the causes of 7^th nerve palsy?
4. What is SIADH?
5. What is ileus?
6. What is Bannwarth Syndrome?
7. How are GI issues related to autonomic dysfunction?

Thanks for listening to another Inside Lyme Podcast. You can read more about these cases in my show notes and on my website @DanielCameronMD.com. As always, it is your likes, comments, reviews, and shares that help spread the word about Lyme disease. Until next time on Inside Lyme.

Please remember that the advice given is general and not intended as specific advice to any particular patient. If you require specific advice, then please seek that advice from an experienced professional.