Painful hallucinations and somatic delusions in a patient with the possible diagnosis of neuroborreliosis

Clin J Pain. Jul-Aug 2005;21(4):362-3. doi: 10.1097/01.ajp.0000120791.69705.12.

Abstract

Neuroborreliosis has become the most frequently recognized tick-borne infection of the nervous system in Europe and the United States. In addition to dermatological, cardiac, articular, and neurologic manifestations, psychiatric disorders such as depression, panic attacks, and schizophrenia-like psychosis can also arise. We report on a 61-year-old woman who developed a severe pain syndrome following several tick bites. She was diagnosed with neuroborreliosis; she received various courses of antibiotics over several years, but without any clinical improvement in her condition. Her eventual admission to a psychiatric ward due to mental symptoms and neuroleptic treatment led to a dramatic improvement of her pain symptoms. However, increasing delusions disclosed a psychotic episode, which ceased over time. We discuss therapeutic difficulties and psychiatric complications in the absence of a clear-cut diagnosis of neuroborreliosis. Although this patient might have suffered from late-onset schizophrenia with painful hallucinations right from the start of her disease, the case highlights psychiatric complications that might be associated with neuroborreliosis.

Publication types

  • Case Reports

MeSH terms

  • Antipsychotic Agents / therapeutic use
  • Borrelia Infections / diagnosis*
  • Borrelia Infections / drug therapy
  • Borrelia Infections / epidemiology
  • Comorbidity
  • Delusions / diagnosis*
  • Delusions / epidemiology
  • Depressive Disorder / diagnosis
  • Depressive Disorder / epidemiology
  • Diagnosis, Differential
  • Female
  • Hallucinations / diagnosis*
  • Hallucinations / epidemiology
  • Humans
  • Lyme Neuroborreliosis / diagnosis
  • Lyme Neuroborreliosis / drug therapy
  • Lyme Neuroborreliosis / psychology
  • Middle Aged
  • Pain / diagnosis*
  • Pain / epidemiology
  • Pain / etiology
  • Pain Measurement
  • Schizophrenia / diagnosis
  • Schizophrenia / epidemiology
  • Schizophrenic Psychology
  • Somatoform Disorders / diagnosis*
  • Somatoform Disorders / epidemiology
  • Treatment Outcome

Substances

  • Antipsychotic Agents