Key result
Lyme disease presents with cranial nerve palsies, SIADH, and AFib potentially triggered by Brugada pattern.
Case Report (n=1)
No
Lyme disease can present with a rare combination of cranial nerve palsies, SIADH, and atrial fibrillation, potentially triggered in patients with underlying predisposing factors like Brugada type II morphology.
We recently encountered a 79-year-old Caucasian man who presented with blurring of vision and facial muscle weakness. The patient also had hyponatraemia, atrial fibrillation with rapid ventricular response and underlying Brugada type II pattern. Urine and serum osmolality were consistent with syndrome of inappropriate antidiuretic hormone secretion (SIADH). It was only after extensive imaging and workup that we were able to tie together these three different presentations of Lyme disease-cranial nerve palsies, SIADH and atrial fibrillation and treat them accordingly. To the best of our knowledge, only eight cases of SIADH in patients with Lyme neuroborreliosis have been reported in the literature. Although our patient did not have a history of arrhythmias, case findings suggest that underlying Brugada type II morphology could have been the predisposing factor, and Lyme disease the trigger.
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Karna et al. (2021) conducted a case report in Lyme disease (n=1). Lyme disease presented as a rare triad of cranial nerve palsies, SIADH, and atrial fibrillation in a 79-year-old man, potentially triggered by an underlying Brugada type II pattern.
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