Lyme disease is a multi-systemic disease caused by the spirochete Borrelia burgdorferi and other borrelia species, and if left untreated it has been associated with neuropsychiatric manifestations. The pathogenesis of Lyme Disease is related to B. burgdorferi surface glycolipids and flagella antibodies that appear to elicit anti-neuronal antibodies. When these proteins disseminate from the periphery, they cause inflammation of the brain, leading to neurodegenerative changes. (Bransfield, 2018) We report a unique case of a 24 year-old male presenting with acute psychosis.

Several months ago, the patient was having grand mal seizures and black outs, leading to a medication change to Tegretol. After his medication change, the patient exhibited bizarre behavior stating he was going to kill his mother and was brought to the ED. When evaluated, he repeatedly stated, “I am innocent” and appeared paranoid. He had no past psychiatric history or family history of mental health conditions. Mental status exam showed mood instability, disorganized thought process, and bizarre behavior. After a thorough investigation of their past medical history, it was discovered he had a past medical history of Lyme disease, Babesiosis, Bartonella, and Q fever. Medical history suggests that this went undiagnosed for years and knowing this new information led the team to suspect a possible progression to a tertiary state of Lyme disease. Patient was admitted to the inpatient unit for 6 days and placed on dual antipsychotic treatment. He was successfully discharged with improvement in symptoms and advised to follow up at an outpatient facility where his antipsychotics would be tapered down. This report highlights the importance in considering infectious causes of psychosis and being cognizant of the long-term complications that these infections can inflict over time.