Lyme Disease and Severe Hyperbilirubinemia: A Rare Presentation of Lyme Disease

Zahoor Ahmed; Asad Ur Rehman; Anum Awais; Abdul Hanan; Sarfaraz Ahmad

doi:10.7759/cureus.8363

Lyme Disease and Severe Hyperbilirubinemia: A Rare Presentation of Lyme Disease

Cureus. 2020 May 30;12(5):e8363. doi: 10.7759/cureus.8363.

Authors

Zahoor Ahmed¹, Asad Ur Rehman², Anum Awais³, Abdul Hanan⁴, Sarfaraz Ahmad⁵

Affiliations

¹ Internal Medicine, King Edward Medical University, Mayo Hospital, Lahore, PAK.
² Internal Medicine, Pakistan Kidney and Liver Research Institute, Lahore, PAK.
³ Internal Medicine, Fatima Jinnah Medical University, Sir Ganga Ram Hospital, Lahore, PAK.
⁴ Infectious Disease, Wayne State University, Detroit, USA.
⁵ Internal Medicine, Saint James School of Medicine, Chicago, USA.

Abstract

A 39-year-old-man presented to the emergency room with a complaint of febrile jaundice and diffuse arthralgia. The patient had a temperature of 100°F, severe jaundice, and scleral icterus. Laboratory workup showed severe hyperbilirubinemia and elevated serum creatinine, and the rest of the serum chemistry was unremarkable. The ultrasound and computed tomography (CT) of the abdomen was normal. The patient had a recent history of travel to an endemic area for Lyme disease. After an extensive workup, all other possible etiologies had been ruled out, and the patient was started on empirical doxycycline by considering the patient's recent history of travel. Serum serologic test confirmed Lyme disease. His bilirubin and creatinine improved gradually. His fever subsided in three days, and he was discharged with outpatient follow-up. Although hyperbilirubinemia is rare in Lyme disease, it should be considered as a differential diagnosis in patients with severe jaundice and a recent history of travel.

Keywords: doxycycline; hyperbilirubinemia; lyme disease.

Publication types

Case Reports