Abstract #: 71017 Lyme Psychosis: Only Treatment is Antibiotics

Pritiben Patel1, Don Walter Kannangara1, Renu Toshniwal1, Dhyanesh Pandya1, Saman Kannangara2, Manasi Revankar1 St Luke’s University Health Network, Warren Campus, Phillipsburg, New Jersey 088651 Easton Hospital, Easton, Pennsylvania 180422 Background Case 1 Discussion Bethlehem Due to manifestations mimicking common conditions, LB associated Lyme borreliosis (LB) is a multisystem disease with cutaneous, A 52-year-old male was seen by a family practitioner for an erythema migrans (EM) rash on right shoulder one week presentations are often missed14,15. Multiple CNS and psychiatric disorders articular, cardiac and neuro-psychiatric manifestations. Multiple after a tick bite. He was started on oral doxycycline. Six days later, suddenly he became agitated, started attacking have been associated with LB. Cases where there was a clear response to psychiatric disorders have been reported in association with LB people and set off alarms in the building by opening emergency exit doors. VS: T 98.0, P 62, RR16, BP118/73 antibiotic treatment suggests a definite etiologic associationAllentown. Acute (Table 1). Here we report 3 cases of LB that presented with psychiatric Labs: WBC 8200, Platelets 165,00, AST 46 (NL 5-45), ALT 33. The patient was brought to the hospital by police , psychosis in cases 1 and 2 were early manifestations. Cognitive changes in manifestations and not recognized by several medical practitioners. In admitted and kept on 1:1 observation under restraints. He refused a spinal tap and intravenous treatment. He was case 3 was a late manifestation. our institution in a tick infested area, we have seen numerous continued on oral doxycycline for three weeks and made a complete recovery.

occasions, where Lyme cases have been misdiagnosed. Here we In areas with LB, recognition of Lyme Psychosis is importantMonroe to report 3 cases of “Lyme Psychosis” that rapidly responded to standard prevent: LB treatment. Three case reports are presented: 1. Unnecessary psychiatric consultations 1. Panic Disorder 2. Inappropriate treatment of patients with psychotropic drugs. 2. Auditory Hallucinations 3. Incorrect labelling of patients as mentally ill. Anderson 3. Confusion and Memory Loss All three of our patients responded to LB treatment.

Table Case 2 References Quakertown Table 1. Reported Psychiatric Disorders associated with Lyme A 59-year-old female was seen in the emergency room for body aches and fever. She was sent home with a diagnosis 1. Sno HN. Tijdschr Psychiatr. Signs and significance of a tick-bite: psychiatric disorders associated with Lyme disease. 2012; 54:235-243 Disease of “flu”. The patient continued to have fevers. The daughter noticed her hallucinating and having conversations with 2. Fallon BA, Nields JA, Parsons B, Liebowitz MR, Klein DF. Psychiatric manifestations of Lyme Borreliosis. J Clin Psychiatry. 1993;54: 263-268 Miners Condition References her dead husband. She was admitted with fever, headache, lightheadedness, photophobia, mental confusion and 3. Pasareanu AR, Mygland Ă, Kristensen Ø. A woman in her 50s with manic psychosis. Tidsskr Nor 1 Cognitive disturbances Sno (2012) auditory hallucinations. She also had left knee pain one day prior to admission. VS: T 101.1, P 86, RR 20, BP 122/65. Laegeforen. 2012; 132:537-539 Depression Fallon et al. (1993)2, Sno (2012)1 Labs: WBC 8100, Platelets 146,00, AST 21, ALT16. Five different health care providers in the emergency room and 4. Johnco C, Kugler BB, Murphy TK, Storch EA. Obsessive-compulsive symptoms in adults with Lyme Panic disorder Fallon et al. (1993)2 hospital ward missed the EM rash on her left shoulder. The patient recalled a tick bite on left shoulder about a week disease. Gen Hosp Psychiatry.2018; 51:85-89 Mania Fallon et al. (1993)2, Pasareanu et al. (2012)3 5. Nagy EE, Rácz A, Urbán E, Terhes G, Berki T, Horváth E, Georgescu AM, ZahariaWarren-Kézdi IE. Diagnostic pitfalls in a young Romanian ranger with an acute psychotic episode. Neuropsychiatr Dis Obsessive compulsive symptoms Johnco et al. (2016)4 prior to admission. She responded to Intravenous ceftriaxone and discharged 2 days later to continue doxycycline for Treat. 2016; 12:961-967 Catatonia Nagy et al. (2016) 5 two weeks. 6. Barnet W, Sigmund D, Roelcke U, Mundt C. Endogenous paranoid-hallucinatory syndrome caused 6 7 Hallucinations Barnet et al. (1991) , van den Bergan et al.(1993) ,Stricker and by Borrelia encephalitis. Nervenarzt. 1991; 62:445-447 Winger (2003)8 7. Van den Bergan HA, Smith JP, van der Zwan A. Lyme psychosis. Ned Tijdschr geneeskd. 1993; 137:2098-2100 “Alice in Wonderland Syndrome” Binalsheikh et al. (2012)9 8. Stricker RB, Winger EE. Musical hallucinations in patients with Lyme disease. South Med J. 2003; Explosive anger 96:711-5 Sudden mood swings 9. Binalsheikh IM, Griesemer D, Wang S, Alvarez-Altalef R. Lyme neuroborreliosis presenting as Alice Dissociative episodes Depersonalization in Wonderland syndrome. Pediatr Neurol. 2012; 46: 185-186 Derealization 10. Bransfield RC. Suicide and Lyme Associated Diseases. Neuropsychiatr Dis Treat. 2017;13: 1575- Social anxiety disorder 1587 Generalized anxiety disorder Bransfield (2017,2018)10,11 11. Bransfield RC. Aggressiveness, violence, homicidality, homicide and Lyme Disease. Neuropsychiatr Substance abuse Dis Treat. 2018; 14:693-73 Hypervigilance Case 3 12. Munir A, Aadil M, Khan AR. Suicidal and homicidal tendencies after Lyme Disease: an ignored Low frustration tolerance problem Neuropsychiatr Dis Treat. 2017; 13: 2069-2071 Post-traumatic stress disorder 13. Rudnik-Szalaj I, Poplawska R, Zajkowska J, Szuic A, Pancewicz SA, Gudel I. Mental disorders in Intrusive aggressive images A 77-year-old female with a history of EM, Positive Western Blot test for LB, pacemaker for heart block, started Intrusive sexual images Lyme disease. Pol Merkur Lekarski. 2001; 65:460-462 Disinhibition recently on outpatient iv ceftriaxone treatment for neuroborreliosis with high CSF protein detected at another hospital 14. Patel P, Kannangara, D, Sindhu S, Toshniwal R, Amit P, Samia H, Kozinn W. A case series of was brought by the family for sudden onset of confusion and memory loss. She developed a fever 100.2. Hgb and Unusual Presentations associated with Arthropod bites: Cutaneous, cardiac, articular and other Suicidality Munir et al. (2017)12, Bransfield (2017)10 manifestations. Poster No: UMP .831; International Congress in Infectious Diseases, Buenos Aires, Homicidality platelet count was low due to a suspected mixed infection with Babesia. Fever, anemia and thrombocytopenia Argentina 2018 15. Kannangara D, Patel P. Report of Non-Lyme Erythema Migrans rashes from New Jersey with a Paranoia Barnett et al. (1991)6, Nagy et al. (2016)5 resolved on treatment with atovaquone and azithromycin. The patient’s memory loss and confusion resolved on review of possible role of tick salivary toxins. Vector borne zoonotic Dis. 2018 In Press Anorexia nervosa Rudnik-Szalaj et al. (2001)13 continued ceftriaxone. She completed a full 6-week course. Corresponding Author [email protected]