El Psiquiatra: Revista Clínica y Terapéutica

Abstracto

Untreated Neuroborreliosis presenting with somatic delusions and subjective memory impairment

Setare Eslami

Lyme disease is a tick-borne spirochete illness with multi involvement. Although neurological manifestations of Lyme disease are becoming increasingly well recognized, its psychiatric presentations are not well known. Physicians need to be aware of its neuropsychiatric symptoms that may present months to years later. Endemic areas to BorelliaBurgdorferi also have higher rates of schizophrenia. Prompt diagnosis and effect treatment is needed to avoid irreversible neuropsychiatric complications. We present a case of a 63 year old male with a psychiatric history of somatic delusions, pressured speech, disinhibition, subjective cognitive complaints with compensatory behavior, and pain on the anterior aspect of the upper torso. Patient believed symptoms stem from pesticide accumulation in fat cells after a single use of pesticides several years prior to initial somatic symptoms. Patient attempted to self-treat with over-the and supplements and sought the help of several internists and specialists. Patient discontinued follow up with several providers due to belief that physicians did not understand the association between his pesticide use and current symptoms. Upon psychiatric evaluation MMSE and MOCA were performed and found to be within normal limits. Subsequent Frontal Assessment Battery was found to be at threshold. Contact with current primary care provider to discuss concerns regarding possible neurologic etiology. MRI of the brain was preformed that demonstrated a frontal lobe hyperintensity. chronic pain of the anterior upper torso and cognitive complaints without change in MOCA performance.