Jarod M. Yancy, BA
Medical Student Researcher
Midwestern University Arizona College of Osteopathic Medicine
Phoenix, Arizona, United States
Post-Treatment Lyme Disease Syndrome (PTLDS)
Case Description:
A 24-year-old male presented to his PCP in April 2021 with 8 months of severe fatigue, diffuse myalgias, night sweats, chills, insomnia, and facial and axillary paresthesia. One year later, symptoms persisted and evolved to diarrhea, vertigo, 40lb weight loss, and several erythematous 1-3cm macules on his axilla and buttocks. Extensive laboratory analysis eventually revealed Lyme immunoassay positive for IgG antibodies, leading to a diagnosis of Latent Lyme Borreliosis. Despite treatment with 2 courses of oral Doxycycline for 28 days, the patient endorsed cyclical recurrences of flu-like symptoms leading to enrollment into a National Institute of Health (NIH) clinical study involving non-FDA-approved treatment with 2g IV ceftriaxone for 30 days in April 2024. This yielded no clinical improvement despite a recent negative Lyme Antibody ELISA immunoassay.
Discussions:
PTLDS is characterized by fatigue, myalgias, arthralgias, and cognitive symptoms persisting for six months or more after appropriate antibiotic treatment for Lyme Borreliosis. One fundamental question is whether persistent symptoms of Lyme Disease, despite the administration of what is currently considered to be adequate antibiotic therapy, are due to latent borrelial infection, a post-infectious syndrome, irreversible sequelae of tissue injury from previous acute infection, or a condition unrelated to Lyme disease. PTLDS is controversial in the medical community because there's no objective biomarker to determine if ongoing symptoms are related to Lyme Borreliosis.
Conclusions: This case report aims to highlight an unusual presentation of PTLDS despite both FDA-approved and NIH-experimental antibiotic treatments. This is useful to consider as a possible indication for rehabilitation services to address the unique needs of patients based on their individualized clinical presentation and physical deficits despite previous medical treatments. Much like sequelae of “long COVID,” PTLDS poses an important consideration for chronic debility in the medical community that should not be overlooked.
