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04 May 2023 : Case report  USA

[In Press] Diagnostic Dilemma in a Case of Lyme Borreliosis Presenting as Severe Anion Gap Metabolic Acidosis: A Case Report

Unusual clinical course, Challenging differential diagnosis, Rare coexistence of disease or pathology

Lindsey A. Wallace1ABDEF, Sarah Cullison1AE, Jacob Bowdon1BCDEF, Aditya Shah2DE, Sumera Ahmad3ADEF

DOI: 10.12659/AJCR.939196

Am J Case Rep In Press; DOI: 10.12659/AJCR.939196  

Available online: 2023-05-04, In Press, Corrected Proof

Publication in the "In-Press" formula aims at speeding up the public availability of the pending manuscript while waiting for the final publication. The assigned DOI number is active and citable. The availability of the article in the Medline, PubMed and PMC databases as well as Web of Science will be obtained after the final publication according to the journal schedule

Lyme disease is a common tickborne disease with a common presentation. Untreated Lyme disease can affect other organs. This can lead to anion gap metabolic acidosis through severe renal failure. Unlike anion gap metabolic acidosis, osmolar gap can be caused by ingestion of ethanol, toxic alcohols, solvents, and salicylates. Therefore, a presentation with osmolar gap and anion gap metabolic acidosis yields a variety of differential diagnoses.
A 72-year-old man presented after being found down. There were few historical cues, and workup was negative for seizures or any acute cerebrovascular incident. Laboratory results were revealing of severe anion gap acidosis with osmolar gap. During clinical decision making and diagnostic dilemma, toxidrome syndromes for potential ingestions and inhalations were sought in addition to thorough workup, which expanded to include infectious etiologies. This patient’s presentation was unique: Lyme disease in the setting of severe anion gap metabolic acidosis with an osmolar gap.
The outcome of critically ill patients can be determined by the clinician’s method to address the diagnostic dilemma and quality of supportive care. Critically ill patient outcomes can be subject to the clinician’s method to address a diagnostic quandary. This unique case poses an important reminder for clinicians to maintain their standard methodologies of critical thinking amidst the noise of distracting medical information.

Keywords: Acidosis; Critical Care; Infectious Disease Medicine; Lyme Disease; Neurotoxicity Syndromes

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923