title: Severe orthostatic hypotension in a diabetic patient may not be due to diabetic autonomic neuropathy.
abstract: This lesson describes an unusual case of a man who was recently diagnosed with type 1 diabetes and who presented with severe orthostatic hypotension. As his diabetes was recent in onset, well controlled, and he had no other signs of microvascular disease, other causes of orthostatic hypotension were sought. His serum and cerebrospinal fluid were strongly positive for Borrelia burgdorferi IgG, suggesting a diagnosis of Lyme neuroborreliosis. Autonomic instability in Lyme, while rare, has been previously reported.
authors: Department of Diabetes and Metabolism, The Royal London Hospital, Whitechapel, London.
authors: M
authors: M
authors: Burman
authors: H L
authors: HL
authors: Nguyen
authors: V
authors: V
authors: Murthy
authors: P
authors: P
authors: Sen Gupta
authors: C
authors: C
authors: Davies
authors: A
authors: A
authors: Wragg
authors: D
authors: D
authors: Peterson
authors: T A
authors: TA
authors: Chowdhury
mesh_terms: D000328:Adult; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D025065:Borrelia burgdorferi / Q000187:drug effects / Q000302:isolation & purification*; D002443:Ceftriaxone / Q000627:therapeutic use*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D003929:Diabetic Neuropathies / Q000150:complications; D006801:Humans; D007024:Hypotension, Orthostatic / Q000150:complications / Q000175:diagnosis / Q000382:microbiology*; D020852:Lyme Neuroborreliosis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy*; D008297:Male; D012720:Severity of Illness Index; D013987:Ticks; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D002443:Ceftriaxone