Acute Flaccid Paralysis Accompanying West Nile Meningitis Ahmed ...

Co-infection with Lyme Disease and Babesiosis
Rosenthal, E, MS III, Merolli, A, MD, Choi, D, MD
Roger Williams Medical Center, Providence, RI; Kent Hospital, Warwick, RI
Introduction: The ixodes scapularis tick is the common vector for both borrelia
burgdorferi and babesia microti and it is important to recognize that both can be
present simultaneously. Our patient presented with both symptoms of Lyme
disease and babesiosis and included Bell’s palsy and hemolytic anemia.
Case: A 58 year old man, with a past medical history of diabetes, presented to
the hospital with facial droop and edema of the face and lower extremities. One
week prior he presented to the emergency room with diffuse arthralgias and
radicular pain down his neck. X-ray of the shoulder was done which was negative
and a Lyme C6 peptide was sent. He was diagnosed with musculoskeletal pain
and sent home. The patient returned to the emergency room one day later with
worsening edema and new complaints of generalized weakness and lethargy.
His workup revealed hyperglycemia and he was admitted to the hospital for
insulin adjustment. There was concern for Lyme disease, however, his C6
peptide was negative. He was discharged home and re-presented three days
later with new facial droop and anasarca. He is an avid hiker and had noticed
numerous tick-bites but denied any history of rash. Initial vital signs were
temperature 98˚ F, heart rate 84, respiratory rate 18 and blood pressure 161/79.
On physical exam the patient was found to have facial swelling, left facial droop
with left facial palsy, lower extremity edema to the groin. Laboratory studies were
significant for an H/H of 9.9/28.4 yet during his admission three days prior his
Hgb had been 12.2. Laboratory studies for hemolytic anemia found LDH of 467
IU/L, haptoglobin