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Suggest Treatment For Raised Blotchy Rash After An Insect Bite

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Posted on Sat, 27 May 2017
Question: I am a 64 year old woman. In 1999 i was bitten by a tick at age 47. That said, i did not have any immediate health problems, except that i noticed a weird raised blotchy rash sometime later, i do not remember the timing. Also i developed severe digestive problems: vomiting and indigestion, or what seemed to be an inability to process certain foods. Then B-12 deficiency and peripheral neuropathies...Around 1999 i also developed a problem with my left retina -- which became what was described to me as chorioretinitis and left me with a blind spot near the macula. In 2000 i became severely "psychotic" and was hospitalized with vivid hallucinations of all five senses, and although they treated me with heavy doses of olanzapine and other anti-psychotic drugs, nothing really helped. At this time i suddenly developed a severe startle reaction to any loud noise or even any sudden thought that popped into my head, which one doctor called "infantile moro-like": i would scream and my hands would jerk up in front of my face reflexively. An EMG showed moderate to severe demyelination of my peroneal nerves. Also, though nothing was noted in my arm muscles when i brushed my cat, my hands would collapse from fatigue after only a minute or two and i could barely walk. A first brain MRI was clear but 6 months later a brain MRI showed new multiple supratentorial white matter hyperintensities (which have neither changed nor gone away) and others over the years also noted an 8mm pituitary cyst and a new 4mm slowly increasing right frontal lobe cavernoma with associated venous anomaly that appears to be bleeding. i was treated for 8 years with antibiotics successfully for Lyme disease and can walk again etc but my personality seems to have undergone changes...In the early 2000's through 2016, when hospitalized or before an episode, i would lose all modesty and strip naked in the public area of the psychiatric hospital....It was completely unlike me! I also quite suddenly developed a passion to do art all the time. I am now in fact a successful and very talented artist now in my mid-60s. My question is, essentially, was this Lyme disease or possibly MS or something else or both? Or was it, as they claimed, just a psychiatric illness? (Which i do not believe) How would i find out?
doctor
Answered by Dr. Ajay Panwar (1 hour later)
Brief Answer:
Unlike to be MS.

Detailed Answer:
Hi xxxx,
Thanks for being on healthcaremagic.com.
I am Dr.Ajay Panwar,a neurologist, here to answer your query.

I have gone through your detailed history. MS is not a likely possibility, neither on basis of attached MRI report and nor on basis of clinical history. MRI lesions in MS have a characteristic appearance and clinical picture is classically marked by relapsing neurological deficits.
Lyme disease is unlikely to cause such chronic florid personality changes and dramatic psychiatric symptoms.

On the other hand, why should a pure Psychiatric syndrome should have peroneal demyelination?

To me, it appears to be Lyme disease with reactionary psychiatric symptoms.MS,of course, appears to be out of picture.

Hope that helps.If you have any further questions,I shall be glad to have you in follow-up.

Regards
Dr.Ajay Panwar,
MD,DM(Neurology)




Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ajay Panwar (6 hours later)
Could the Cavernoma and blood in my right frontal lobe, which is not characterized further than that, account for personality changes and perhaps even the passion to do art? It seems strange that all these things happened around the same time. Also, I have severe migraine headaches, that did not go away with menopause, and ECT-induced seizures (which started immediately followed a series of shock treatments in 2003 and 2004) that consist of episodes of jamais vu and olfactory hallucinations of burning rubber, which are treated with AEDs to this day. As far as that goes, could ECT trigger bleeding in a cavernoma?
doctor
Answered by Dr. Ajay Panwar (13 hours later)
Brief Answer:
Small lesion may not cause such florid personality changes.

Detailed Answer:
Hi xxxx,
Thanks for being in follow-up and providing further details.

I saw the MRI report which mentions of a small cavernoma, which may not be the cause of such florid personality changes.

Further,ECT should not usually trigger bleeding in cavernoma, though neurosurgeon's opinion can be taken for the same. Migraine can of course be problematic, and can be best managed by avoidance of trigger factors.

Hope that helps.If you need further clarification on these issues,I shall be glad to have you in follow-up.

Regards
Dr.Ajay Panwar,
MD,DM(Neurology)


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ajay Panwar (2 hours later)
Okay, i guess the one question i have is this: do you see anything in my history or reports of MRI that could account for these personality/behavioral changes? Could Lyme induce severe recurrent psychosis, and hallucinations of sight, sound, touch, taste and smell? These have since greatly diminished so that i only now experience occasional derogatory "voices" and command auditory hallucinations, which i deal with okay. Also what could account for this very sudden -- quite literally overnight -- passion to do art?
doctor
Answered by Dr. Ajay Panwar (1 hour later)
Brief Answer:
Lyme is less likely to be the cause of severe recurrent psychotic symptoms.

Detailed Answer:
Hi xxxx,
Thanks for being in follow-up again.

Lyme disease apparently is not the cause of such severe recurrent psychotic symptoms and hallucinations along with dramatic personality changes.

Further, on the basis of above history this sudden passion towards art goes unexplained. Possible, a consultation with Psychiatrist will be of help in this regard.

If you have further questions,you are most welcome else please close the thread,rate it and write a review.

Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Ajay Panwar

Neurologist

Practicing since :2007

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Suggest Treatment For Raised Blotchy Rash After An Insect Bite

Brief Answer: Unlike to be MS. Detailed Answer: Hi xxxx, Thanks for being on healthcaremagic.com. I am Dr.Ajay Panwar,a neurologist, here to answer your query. I have gone through your detailed history. MS is not a likely possibility, neither on basis of attached MRI report and nor on basis of clinical history. MRI lesions in MS have a characteristic appearance and clinical picture is classically marked by relapsing neurological deficits. Lyme disease is unlikely to cause such chronic florid personality changes and dramatic psychiatric symptoms. On the other hand, why should a pure Psychiatric syndrome should have peroneal demyelination? To me, it appears to be Lyme disease with reactionary psychiatric symptoms.MS,of course, appears to be out of picture. Hope that helps.If you have any further questions,I shall be glad to have you in follow-up. Regards Dr.Ajay Panwar, MD,DM(Neurology)