Authors: Chandra S Pingili, Saleh Obaid, Kyle Dettbarn, Jacques Tham, Greg Heiler.
Background: Medical syndromes often overlap in clinical presentations. Often there is one or more than underlying etiology responsible for the patient’s Clinical presentation. We are reporting a patient who was initially admitted with fevers and joint pains.Lymes IGG was positive .He was discharged home on Doxycycline and Prednisone suspecting gout. Patient however was re admitted twice within 3 weeks with cognitive impairment. Lymph node biopsy was positive for non Caseating granulomas suggesting Sarcoidosis. Clinically he responded dramatically to steroids.
Case Report: 74 year old white male was admitted with fever and multiple joint pains. Tmax was 100.5.WBC was 15 with normal CBC. LFTs were elevated. Rest of the labs were normal.Lymes IGG was positive. He underwent extensive Rheumatological and virological evaluation. Sonogram of the abdomen was negative. He responded to IV Ceftriaxone and was discharged home on Doxycycline for 3 weeks and Prednisone taper for a week. He was readmitted within 2 weeks with weakness and confusion. After ruling out multiple etiologies he was discharged home on IV Ceftriaxone suspecting Neuroborreliosis.But he was re admitted with worsening mentation in a week. This time he was diagnosed with Neurosarcoidosis with a lymph node biopsy. He responded dramatically to IV steroids, Methotrexate and one dose of Infliximab. Patient continues to follow up with the clinic and is now at his base line with no recurrence.
Conclusion: He is one patient where an underlying disabling pathology was missed twice. He is a case of chronic Lyme that was successfully treated to begin with. However he is also a case of Neurosarcoidosis Masquerading as Nueroborreliosis. Rarely is a clinical encounter so perplexing.
This case also supports the existing literature that extended use of antibiotics for Lyme disease has no short term or long term benefits; instead it will put the patient at a risk of drug toxicity. From Palliative care evaluation in the hospital this gentleman is now back to his base line and is totally independent for activities of daily living.
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