Painful Hallucinations and Somatic Delusions in a Patient With the Possible Diagnosis of Neuroborreliosis

• Published in: The Clinical journal of pain Vol. 21; no. 4; pp. 362 - 363
• Main Authors: Bar, Karl-Jürgen, Jochum, Thomas, Hager, Frank, Meissner, Winfried, Sauer, Heinrich
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins, Inc 01-07-2005; Lippincott Williams and Wilkins
• Subjects: Antipsychotic Agents - therapeutic use; Biological and medical sciences; Borrelia Infections - diagnosis; Borrelia Infections - drug therapy; Borrelia Infections - epidemiology; Comorbidity; Delusions - diagnosis; Delusions - epidemiology; Depressive Disorder - diagnosis; Depressive Disorder - epidemiology; Diagnosis, Differential; Female; Fundamental and applied biological sciences. Psychology; Hallucinations - diagnosis; Hallucinations - epidemiology; Humans; Injuries of the nervous system and the skull. Diseases due to physical agents; Lyme Neuroborreliosis - diagnosis; Lyme Neuroborreliosis - drug therapy; Lyme Neuroborreliosis - psychology; Medical sciences; Middle Aged; Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis; Neurology; Pain - diagnosis; Pain - epidemiology; Pain - etiology; Pain Measurement; Schizophrenia - diagnosis; Schizophrenia - epidemiology; Schizophrenic Psychology; Somatoform Disorders - diagnosis; Somatoform Disorders - epidemiology; Somesthesis and somesthetic pathways (proprioception, exteroception, nociception); interoception; electrolocation. Sensory receptors; Traumas. Diseases due to physical agents; Treatment Outcome; Vertebrates: nervous system and sense organs; Human; Nociception; Psychosis; Nervous system diseases; Pain; neuroborreliosis; Hallucination; Central nervous system; Delusion; Schizophrenia; Diagnosis
• ISSN: 0749-8047; 1536-5409
• DOI: 10.1097/01.ajp.0000120791.69705.12

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.