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What Causes Red Rash,dizziness And Tingling In Body After A Tick Bite?

Posted on Mon, 29 Sep 2014

Question: My husband was bitten by a tick last summer in his groin. A red circular rash developed with a pustule at the site of the bite. 2 weeks later, he developed dizziness, unsteady gait and balance problems, and an enlarged liver and tingling on the right side of his body. He was hospitalized and treated with Rocephin. followed by Doxycycline. Lyme test was negative by Western blot. One year later he is developing the same symptoms. Sometimes he tries to walk and his body won't move. He is complaining of RUQ abdominal pain, occasional loss of coordination. Tingling on the right side of his body when touched and joint stiffness in his right leg. He is a diabetic and has a history of an MI. MRI of head is negative. Doppler of neck shows less than 50% occlusion. CT scan revealed a small lung nodule, RLQ. What do you think he has? Thank You

Answered by Dr. Noble Zachariah (2 hours later)

Brief Answer:
Different possibilities discussed

Detailed Answer:
Hello,

I understand your husband's symptoms.
It is very unlikely that his present symptoms are due to the tick bite one year ago. He has diabetes and has had a myocardial infarction. So he has narrowing of his blood vessels which occurs not only in the heart but all over the body including the brain. Only a total occlusion produces a stroke. There are varying degrees of narrowing producing an insufficiency of blood flow. These may not be detected by MRI as these may be episodic producing a transient ischemic attack ( TIA) which resolves within 24 hours.
Another possibility of unsteadiness of gait is the side effect of Neurontin. I would be interested in knowing why he is on that medicine.
What is the diagnosis of the lung nodule? I am just mentioning this for completion's sake and I hope it is not. This can even be a non metastatic manifestation of a small cell carcinoma of the lung.
If you have further queries, please do not hesitate to ask.
Take care
Dr. Noble Zachariah

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Noble Zachariah (11 hours later)

My husband was placed on Neurontin for numbness in his feet and tingling on his right side. The neurologist thought it might be a pinched nerve in his neck causing the tingling on his right side. Question: I thought all carcinomas are malignant? When my husband was on doxycycline both this year and last the gait disturbance disappeared, why is that? Thank you

Answered by Dr. Noble Zachariah (1 hour later)

Brief Answer:
Improvement with antibiotic points to an infection

Detailed Answer:
Hello,

I am sorry if I made you think that your husband has a malignancy. I just mentioned it as a differential diagnosis for the lung nodule. Was a diagnosis made on the same?
If the gait disturbance disappeared with the antibiotic Doxycycline, it points to an infection like a urinary tract infection or a chlamydial infection. An infection in a person with diabetes who may have some vascular insufficiency can cause some gait disturbance. Since he is taking Neurontin for only tingling and not for any seizure, he could try stopping it for a week and see if it improves the gait disturbance.
Wishing him good health
Dr. Noble Zachariah

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Above answer was peer-reviewed by : Dr. Shanthi.E