SHM Converge Scientific Abstract ePoster Gallery-A Rare and Unusual Case of Lyme Myositis.

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This case report describes a rare presentation of Lyme myositis (LM) in a 68-year-old man with a history of non-Hodgkin lymphoma in remission. He presented with 6 months of progressive proximal muscle weakness and 50-pound weight loss. On exam, he appeared cachectic and ill, with inability to lift his legs against gravity, a small left knee effusion, and mild bilateral Babinski signs.<br /><br />Work-up showed normal creatine phosphokinase, mildly elevated aldolase, and elevated CRP. Lyme serology was negative by Western blot despite a positive ELISA, but the patient had severe hypogammaglobulinemia, which may have impaired antibody production. MRI demonstrated bilateral diffuse subcutaneous and fascial edema in the pelvic and thigh muscles, consistent with inflammatory myopathy. Cerebrospinal fluid and synovial fluid from the left knee both showed inflammatory findings with positive Lyme PCR. Muscle biopsy revealed perifascicular atrophy, scattered T-cells, and perimysial macrophage collections, supporting inflammatory myositis.<br /><br />The report emphasizes that Lyme disease usually presents as erythema migrans, neurologic involvement, carditis, or arthritis, while myositis is very uncommon and can be difficult to diagnose. In this patient, the diagnosis required a high index of suspicion and was supported by PCR and biopsy despite negative standard serology.<br /><br />The authors conclude that Lyme myositis is a rare but treatable manifestation of Lyme disease that should be considered in patients with unexplained muscle weakness and inflammatory features. Prompt recognition is important because it responds well to antibiotic therapy, with improvement in symptoms.

Asset Subtitle

Babray Laek

Meta Tag

Author List Babray Laek, Kushaan Mehta, Thomas Pearce, Vikas Singh, Yong Hwang

Category Clinical Vignettes

Concept Lyme Disease

Concept Myositis

Concept Lyme PCR

Concept Antibiotic Therapy

Concept Disease Staging

Distinguished Non-Finalist

Presenter Organization UPMC McKeesport

Presenting Author Babray Laek

Track Adult

Keywords

Lyme myositis

Lyme disease

muscle weakness

inflammatory myopathy

positive Lyme PCR

hypogammaglobulinemia

muscle biopsy

MRI edema

proximal weakness

antibiotic therapy

Lyme Disease

Myositis

Lyme PCR

Antibiotic Therapy

Disease Staging