A Very Rare Case of ‘Lyme-Induced Pancreatitis’

Abstract

Introduction: Lyme disease is the most common vector borne infection in the united state, There have been multiple cases of borreliosis reported across the world especially in North America and Europe in which the course of disease was characterized by long standing high fever, enlargement of liver and spleen, pancreatitis, pneumonia and anemia. Many GI manifestation of borreliosis have been reported in literature but involvement of the pancreas has so far not been reported. We describe a case of pancreatitis in a patient with serology-proven lyme disease (Borreliosis). Case Description: This is the case of 20 year old Caucasian female presented to ED with complaint of abdominal pain and generalized body aches. In late June she went camping in upstate, New York. She stayed there for the entire month, she had a tick bite during camping and tick was removed immediately; no symptoms reported at that time. Week later, she developed abdominal pain, nausea, vomiting and fever and was admitted in the hospital New York and was found to have pancreatitis. Lipase was elevated at 1250. Discussion: History of tick bite, rash with central clearing with bull's eye appearance is Erythema Migrans, the characteristic rash of early course of lyme disease. Abdominal pain, nausea, vomiting, with elevated lipase is characteristic symptoms of pancreatitis. Diagnosis of acute pancreatitis is established on clinical symptoms and laboratory testing. According to American College of Gastroenterology guidelines, the presence of two of the following three characteristics is sufficient for the diagnosis acute pancreatitis: Abdominal pain, serum lipase higher than three times the upper limit, and radiographic evidence of acute pancreatitis. The patient had 2 of these three characteristics. There has been no case reported associated with Lyme pancreatitis till today, the reason of reporting this case is to highlight the difficulty in diagnosing borreliosis. As borreliosis is multisystem disease and there have been reported cases where diagnosis was difficult to reach we suggest exploring other manifestation of this disease.