Postpartum Neurological and Systemic Symptoms Overlooked as Possible Lyme Disease: A Case of Delayed Diagnosis

Published on: 2025-02-22 21:20:00

Brief Presentation

H.M. began experiencing a series of progressively worsening neurological and systemic symptoms following the birth of her third child via cesarean section with spinal anesthesia in August 2024. Initially, she struggled with severe headaches and general weakness, making it difficult for her to get out of bed. Over the following month, she developed a range of concerning symptoms, including persistent numbness and tingling sensations in her limbs, sharp pain in her joints, unexplained muscle stiffness, and increasing sensory disturbances.

As her condition worsened, she visited multiple specialists, including neurologists, orthopedists, and rheumatologists, and underwent extensive medical testing, yet no definitive diagnosis was made. Doctors suggested conditions ranging from postpartum nerve damage to suspected multiple sclerosis (MS), but all investigations remained inconclusive. After months of suffering, H.M. independently pursued an Immunoblot test for Lyme disease, which returned clearly positive results, finally providing an explanation for her ongoing health decline.

Conclusion

H.M.’s case highlights the frequent misdiagnosis and dismissal of Lyme disease in Europe due to reliance on insufficient diagnostic tests, lack of awareness, and the common assumption that symptoms must be linked to known conditions like postpartum complications, autoimmune diseases, or multiple sclerosis. Despite displaying a textbook progression of neurological and systemic Lyme disease symptoms, she was repeatedly misdiagnosed, subjected to ineffective treatments, and left searching for answers on her own. The case underscores the critical need for improved Lyme disease diagnostic protocols, better physician education, and early intervention to prevent long-term disability in patients suffering from tick-borne infections.

Medical History

Postpartum Period (August 2024): Severe headaches, generalized weakness, and difficulty standing after spinal anesthesia for cesarean delivery.
Neurological Symptoms Begin (One Month Later):
- Right foot numbness (heel pain, burning sensation).
- Left foot sensory disturbances (sensation of a foreign object under the toes while walking).
- Left hand weakness and numbness (inability to stretch fingers, pulling sensation along the entire arm).
- Spread of symptoms to additional limbs: Middle and ring fingers of the left hand became permanently numb and painful.
- Nerve-like tingling and shooting pain throughout the body.
Bloodwork and Initial Consultations:
- CRP levels were elevated (55 mg/L), which was dismissed as "normal for a postpartum woman."
- Vitamin D and B12 levels were within normal range.
Neurological Consultation and Misdiagnosis:
- Initial neurologist diagnosed elbow nerve inflammation and prescribed methylprednisolone (40 mg) and topical anti-inflammatory creams (no improvement).
- A second neurologist suspected multiple sclerosis (MS) and referred her for hospitalization.
Hospital Admission and Further Worsening:
- Hospitalized for suspected MS but had to wait 4–5 days for an MRI.
- During hospitalization, administered IV methylprednisolone (125 mg).
- New symptoms developed: Numbness of the tongue, lower lip, and chin, which persisted for 4 months and led to ulcer-like lesions.
- MRI of the brain and cervical spine ruled out MS, leading to discharge with the vague diagnosis of "cervical nerve root damage."
Rheumatology Consultations and Further Dismissals:
- Tested for autoimmune diseases (ANA and other markers) → Negative.
- One rheumatologist suggested reactive arthritis, prescribed Azithromycin 500 mg for 10 days, but no improvement.
- Right thigh muscle stiffness and restricted movement appeared after treatment.
Repeated Negative Lyme Disease Testing and Physiotherapy:
- Ordered basic Lyme disease serology, which returned negative.
- Attended physiotherapy, but instead of improvement, developed numbness in the right abdominal region up to the ribs.
Discovery of a Persistent Wound and Possible Tick Bite:
- Noticed a poorly healing wound on the upper foot that left a dark scar with transparent skin.
- No recollection of a recent tick bite, though she had one 30 years ago.
Final Lyme Disease Test (Immunoblot - Positive):
- After months of searching for answers, ordered an Immunoblot test for Lyme disease, which came back clearly positive, confirming a late-stage Borrelia infection.

Symptoms

Neurological Dysfunction:
- Persistent numbness and tingling in hands, feet, and face.
- Loss of fine motor control in hands.
- Muscle spasms, stiffness, and shooting nerve pain.
- Sensory abnormalities, including sensations of foreign objects in the feet.
- Development of ulcer-like lesions on the numb areas of her tongue and lower lip.
Musculoskeletal and Joint Symptoms:
- Persistent joint pain and stiffness in hands, feet, and legs.
- Weakness in limbs, difficulty stretching fingers or moving legs.
- Increased muscle tightness and new-onset thigh stiffness.
Cardiovascular and Autonomic Symptoms:
- Strong palpitations, even while at rest.
Skin and Wound Healing Issues:
- Unexplained non-healing wound on the foot that left a dark scar with transparent skin.
Postpartum Fatigue and Weakness:
- Extreme exhaustion following childbirth, taking weeks to regain minimal mobility.

Diagnostic Tests

CRP Levels: Elevated (55 mg/L) – initially dismissed as "normal postpartum inflammation."
MRI of Brain and Cervical Spine: No signs of multiple sclerosis.
Autoimmune Panel (ANA, AST, etc.): Negative results.
Basic Lyme Serology: Negative.
Immunoblot for Lyme Disease: Clearly Positive, confirming Borrelia infection.

Diagnosis and Treatment Challenges

Dismissal of Symptoms: Medical professionals repeatedly downplayed H.M.'s symptoms as either postpartum changes, orthopedic issues, or stress-related conditions rather than investigating tick-borne diseases.
Delayed Lyme Disease Testing: Despite extensive neurological symptoms, Lyme disease was not considered a possibility until months after symptom onset.
Reliance on ELISA Testing: The initial negative Lyme disease test contributed to diagnostic delays, as doctors dismissed Lyme disease as a cause without further testing.
Hospitalization for Suspected MS: Although MS was ruled out via MRI, no alternative diagnosis or further investigation into infectious causes was pursued.
Multiple Rheumatology Consultations: Despite clear inflammatory symptoms, multiple specialists failed to provide a unifying diagnosis, with some suggesting reactive arthritis without addressing the neurological issues.

Outcomes

Neurological Symptoms Persist: Even after months, numbness in the face, tongue, and limbs remains unresolved.
Late Diagnosis: H.M. endured months of suffering before finally obtaining a positive Immunoblot test, confirming a late-stage Lyme disease diagnosis.
Significant Physical and Emotional Toll: The uncertainty, medical dismissal, and worsening symptoms have taken a severe toll on her physical and emotional well-being.

Differential Diagnosis

Chronic Lyme Disease / Neuroborreliosis: Positive Immunoblot test, progressive neurological dysfunction, and musculoskeletal symptoms align with late-stage Lyme disease.
Postpartum Nerve Damage: Initial spinal anesthesia could have caused some numbness, but the ongoing worsening neurological symptoms point to an infectious cause rather than postpartum complications.
Multiple Sclerosis (Ruled Out): MRI confirmed no MS-related lesions.
Autoimmune Disorders (Ruled Out): Negative ANA and other autoimmune markers suggest an infectious rather than autoimmune cause.

Future Recommendations

Immediate Initiation of Lyme Disease Treatment: Given the clearly positive Immunoblot test, H.M. requires urgent antibiotic therapy, possibly starting with intravenous ceftriaxone due to the neurological involvement.
Specialist Evaluation for Co-Infections: Additional testing for co-infections such as Babesia and Bartonella is recommended.
Multidisciplinary Care Approach: Neurologists and infectious disease specialists should collaborate to address her neurological symptoms and musculoskeletal dysfunction.
Raising Awareness in Postpartum Lyme Disease: Her case demonstrates the urgent need for physician education on postpartum Lyme disease presentations, which may be mistakenly attributed to anesthesia, pregnancy-related changes, or autoimmune conditions.

Broader Implications

H.M.’s case highlights severe flaws in Europe’s Lyme disease diagnostic and treatment protocols. The failure to recognize Lyme disease, reliance on insensitive ELISA tests, and dismissive attitudes toward patients with complex symptoms contribute to delayed diagnoses and prolonged suffering. This case calls for urgent reforms in medical training and diagnostic approaches to prevent future cases from being overlooked.

Analysis of H.M.’s Case: Diagnostic Failures and the Overlooked Connection Between Postpartum and Neurological Lyme Disease

H.M., a woman from Europe, developed progressively worsening neurological and systemic symptoms following the birth of her third child via cesarean section with spinal anesthesia in August 2024. Initially dismissed as postpartum complications or potential multiple sclerosis (MS), her condition deteriorated over several months, leaving her searching for answers on her own. After extensive medical consultations and repeated misdiagnoses, an Immunoblot test finally revealed a late-stage Borrelia infection, confirming Lyme disease. This case underscores the frequent misdiagnosis of tick-borne diseases in Europe, the limitations of standard diagnostic protocols, and the critical need for increased awareness of Lyme disease presentations in postpartum women.

Missed Diagnostic Opportunities and Systemic Delays in Care

Postpartum Period and Early Neurological Symptoms

H.M.’s symptoms began immediately after her cesarean section, initially manifesting as severe headaches and generalized weakness that made it difficult for her to stand. While postpartum fatigue and mild neurological disturbances are not uncommon after childbirth, the rapid progression of numbness, tingling, and burning sensations in her limbs within the first month should have warranted a broader diagnostic workup beyond routine postpartum evaluations.

Her sensory disturbances in the hands and feet, such as the sensation of a foreign object under her toes and persistent numbness, indicated possible peripheral neuropathy, a hallmark of neuroborreliosis. However, her symptoms were misattributed to elbow nerve inflammation, delaying proper neurological evaluation.

Misdiagnosis and the Dismissal of Lyme Disease

Neurological Consultations and Misguided Focus on Multiple Sclerosis (MS)

As H.M.'s symptoms spread to her face and limbs, she was referred for neurological evaluation, where MS was strongly suspected. Despite this concern, she was subjected to significant delays before undergoing an MRI scan, waiting nearly a week while being treated with IV methylprednisolone (125 mg)—an immunosuppressive therapy that may have worsened her infection if Lyme disease was present.

Her MRI ultimately ruled out MS, yet instead of considering alternative explanations, she was discharged with a vague diagnosis of "cervical nerve root damage," offering no explanation for her multi-systemic symptoms. The fact that Lyme disease was never considered at this stage represents a major failing in diagnostic reasoning, particularly given her neurological dysfunction and inflammatory markers (CRP: 55 mg/L).

Rheumatology Consultations and Misguided Treatment

After being discharged, H.M. pursued rheumatology consultations to explore the possibility of autoimmune disease. Despite experiencing clear signs of inflammation, joint pain, and muscle stiffness, her autoimmune panel (ANA, AST, etc.) returned negative. Rather than considering infectious causes, one rheumatologist suggested reactive arthritis and prescribed Azithromycin (500 mg for 10 days)—a short course of antibiotics insufficient to treat Lyme disease, likely contributing to her worsening symptoms.

Instead of improving, H.M. developed muscle stiffness in the right thigh and new sensory disturbances in her abdomen, indicating a progressive neurological process that was not addressed by her treatment. The persistent numbness of her tongue, lower lip, and chin, which lasted for four months, suggests cranial nerve involvement—another hallmark of neuroborreliosis.

Failures in Lyme Disease Testing and Delayed Diagnosis

False-Negative Lyme Serology and Over-Reliance on ELISA

Despite her worsening symptoms, basic Lyme disease serology was ordered but returned negative, leading her doctors to dismiss Lyme disease as a possibility. This highlights the well-documented limitations of ELISA testing, particularly in late-stage Lyme disease, where the immune response may be weak or fluctuating, leading to false negatives.

This unnecessary reliance on a single, insensitive test contributed to months of diagnostic delays. Given her progressive neurological symptoms, direct diagnostic tests such as Immunoblot or PCR should have been ordered immediately instead of relying solely on ELISA.

Self-Directed Testing and Confirmatory Immunoblot Results

Frustrated by the lack of answers, H.M. independently sought an Immunoblot test, which returned clearly positive for Lyme disease, confirming a late-stage Borrelia infection. This test result finally explained her symptoms and exposed the major diagnostic failures that led to months of suffering and misdiagnosis.

Symptoms and Clinical Findings: A Textbook Case of Neuroborreliosis

H.M.’s symptoms align precisely with chronic Lyme disease and neuroborreliosis, including:

Neurological Dysfunction

Persistent numbness and tingling in hands, feet, and face
Loss of fine motor control in hands
Muscle spasms, stiffness, and shooting nerve pain
Cranial nerve involvement (numbness of tongue, lip, and chin)
Sensory abnormalities, including "foreign object" sensations in the feet

Musculoskeletal and Joint Symptoms

Persistent joint pain and stiffness in hands, feet, and legs
Weakness in limbs, difficulty moving fingers and legs

Cardiovascular and Autonomic Symptoms

Strong palpitations, even while at rest

Skin and Wound Healing Issues

Unexplained non-healing wound on the foot that left a dark scar with transparent skin
Possible unnoticed tick bite

Postpartum Fatigue and Weakness

Extreme exhaustion after childbirth, taking weeks to regain minimal mobility

Missed Opportunities for Early Treatment

If Lyme disease had been considered earlier—especially when her symptoms rapidly progressed postpartum—H.M. could have received timely treatment and avoided prolonged neurological damage. The failure to recognize her symptoms, reliance on false-negative ELISA results, and continued misattribution of symptoms to postpartum complications contributed to her preventable suffering.

Recommendations for Immediate and Long-Term Management

1. Urgent Lyme Disease Treatment

Immediate IV antibiotic therapy (ceftriaxone or penicillin G) to address neuroborreliosis
Transition to oral antibiotics (doxycycline, azithromycin, or cefuroxime) for long-term treatment
Possible addition of anti-inflammatory and neuroprotective agents

2. Additional Testing for Coinfections

Testing for Babesia and Bartonella, common Lyme co-infections that can contribute to persistent neurological symptoms
Evaluation of immune function to assess potential long-term Lyme-related complications

3. Multidisciplinary Care Approach

Neurologists and infectious disease specialists should collaborate on treatment
Physical therapy and rehabilitation to address muscle stiffness and mobility issues
Nutritional and mitochondrial support to aid neurological recovery

4. Raising Awareness of Postpartum Lyme Disease

Improved medical training on postpartum Lyme disease presentations
Encouraging doctors to consider infectious causes in women experiencing severe postpartum neurological symptoms

Broader Implications: The Need for Systemic Reform in Lyme Disease Diagnosis

H.M.’s case reveals critical gaps in the European medical system’s approach to Lyme disease, particularly:

Over-reliance on ELISA testing, leading to false negatives and missed diagnoses
Failure to recognize postpartum Lyme disease symptoms, attributing them to MS, nerve damage, or stress
Dismissive attitudes toward women’s health concerns, contributing to prolonged suffering and misdiagnosis
Lack of awareness among specialists, resulting in ineffective treatments and unnecessary hospitalization

By updating diagnostic protocols, educating healthcare providers on Lyme disease symptomatology, and implementing more sensitive testing approaches, Europe could prevent similar cases of delayed diagnosis and long-term disability.

Conclusion: A Call for Change

H.M.’s case exemplifies the devastating consequences of medical dismissal, misdiagnosis, and inadequate Lyme disease testing. The reliance on insensitive ELISA testing and the refusal to consider alternative explanations delayed her diagnosis for months, allowing her condition to worsen.

This case serves as a wake-up call for healthcare systems to improve Lyme disease awareness, diagnostic accuracy, and treatment accessibility. If Europe fails to address these issues, many more patients will continue to suffer from preventable neurological decline and long-term disability.