A recent case study published in the journal Tropical Medicine and Infectious Disease caught my eye the other day largely because it highlights the challenges Canadian doctors can face in trying to diagnose tick-borne illnesses.
The case involved a 65-year-old man from southern Ontario who had fallen ill while vacationing in Ecuador and the Galápagos Islands. At first he thought he was suffering from altitude sickness, but then he started to develop odd rashes on his chin, lower back and buttocks. His initial thought was that he had been bitten by an insect in South America.
The man's rashes would soon resolve, but when he returned to Ontario, he was plagued by fatigue, muscle pain, a short-lived fever and just generally felt unwell. He also developed another rash, this one the classic bull's eye associated with Lyme disease. He went to an emergency room in Toronto and began treatment for Lyme disease that day.
But that wasn't the end of it. His symptoms continued to worsen. While being treated for Lyme disease, he developed Bell's palsy on the right side of his face and was having difficulties controlling the movement of his tongue. Bell's palsy is common in advanced Lyme disease. Impairment of the primary nerve that controls the tongue (cranial nerve XII) is not.
Because the man had first fallen ill while in Ecuador, tropical illnesses had to be considered as the reason why the man continued to deteriorate. Non-infectious causes were also considered. One by one every other potential cause for the man's ongoing symptoms would be eliminated until Lyme disease was the last one standing.
Further inquiries would determine that the man had spent a significant amount of time taking his dog for long walks in a region of southern Ontario known to have a lot of Lyme-infected ticks.
This case underlines a problem with diagnosing Lyme disease: the illness can be such a chameleon. Although there are core symptoms associated it -- the bull's eye rash being the most famous example -- many Lyme patients have also reported oddball symptoms that seem to suggest medical issues unrelated to infection with Lyme bacteria. In this case, the patient had been infected with Lyme while in Ontario, fell ill in South America, then developed some unexpected symptoms when returning home. It had been easy to think that he had picked up a tropical illness because of where he had visited and when his illness had begun to manifest. But those things would ultimately turn out to be red herrings. The seemingly exotic disease would turn out to be a disease newly endemic to Canada.
It would be lovely to see this article reproduced in a Canadian medical journal where it would surely gain a higher profile with Canada's doctors and serve as a reminder that Lyme can manifest with some pretty odd symptoms sometimes and can be the culprit even when other diseases may seem more likely.
Photo by Andy Brunner on Unsplash
