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What Causes Yellowing Of White Part Of Eye In A Patient With Lyme Disease?

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Posted on Mon, 2 Mar 2015
Question: I was writing again with another question concerning my 18-year-old son. He has been treated for Lyme Disease by a Lyme Disease Specialist since last October. Before that, he was being treated by a regular disease specialist since XXXXXXX for lyme disease. He has had symptoms for it since last March but wasn't diagnosed until XXXXXXX His symptoms have never gotten better, stayed the same the whole time. He still is lethargic with a low-grade headache that never leaves. I'm also concerned now because the whites of his eyes are looking yellow. He said seven people at college commented about it also. His last blood test, his Bilirubin total was 2.2. The Glucose Serum said 61 and indicated that was low. He is getting a blood test every two to three weeks due to the amount of medicine he's taking. We don't know what to do next. Nothing seems to be working. If there's anything in his diet that he should also include to help with his liver and eyes, please let me know. Below are his current prescriptions:
doctor
Answered by Dr. Tushar Kanti Biswas (4 hours later)
Brief Answer:
Lyme disease

Detailed Answer:
Hi,

Thank you for your query. I can understand your concerns.
Lyme Disease can cause hepatitis. Yellow sclera of eyes is due to jaundice. However serum blirubin 2.2 mg/dl indicates mild jaundice. Let me know his SGOT & SGPT levels ,if done as part of liver function tests.

Azithromycin sometimes can cause cholestatic jaundice. Doxycycline however is free of hepatic side effects.

Despite treatment of the infection with antibiotic therapy, a small percentage of patients may have fatigue symptoms for months .

Your son is however getting standard antibiotic therapy for Lyme disease ie doxycycline & azithromycin.

For patients with disseminated infection, a 21-day course is usually recommended.
Intravenous administration of ceftriaxone is sometimes recommended in late infections.

Regards

Dr. T.K. Biswas M.D. XXXXXXX
     
Hit thanks if it helps

Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Tushar Kanti Biswas (6 hours later)
Dear Dr. Biswas,
Thank you so much for all of your helpful information. This has been such a stressful year with XXXXXXX not feeling like himself and trying to get good grades while away at college. His SGOT was 19 and his SGPT was 15. He has been on constant antibiotics since last XXXXXXX with symptoms starting in March but not diagnosed for three and a half months. He started out with Doxycyline, 100 milligrams, twice a day for two months, and didn't help. The doctor then ordered a spinal to take fluid out of spine to test for lyme. The result came back a mild positive for lyme from the fluid. He then told us he didn't know what to do next. That's when we took him to lyme specialist. XXXXXXX started there with high dose of Amoxycillin and 1/2 tablet Azythromycin each day, along with probenacid to keep the antibiotic in his system longer. After that, he took Cefdinar for about a month with Azythromycin. Then she added the mepron. He's also taking the supplements. Nothing seems to take the headache away and is still tired. His doctor is wanting to keep him on the Doxycycline and Azythromycin through his spring semester. And then when he comes home, if still not better, to start the IV treatment. As he plays golf, she didn't think he could have an iv line in his arm. I'm wondering if he should stop the antibiotics since they are not helping and then wait until this summer for the IV treatment or get several doses of IV treatment now and see if that helps. He is also taking Mepron, which I'm wondering if that is causing more problems with his liver than helping. I just don't see the benefit of taking antibiotics for such a long period of time. But if he stopped them, would the infection get worse? Lyme Disease is such an unknown disease, it seems. Also, is there anything he should be doing for the mild jaundice? I apologize for this lengthy question but your answer was very helpful. Thank you so much for the time and thought you have taken to help us. It means more than you know.
XXXXXXX
doctor
Answered by Dr. Tushar Kanti Biswas (2 hours later)
Brief Answer:
Lyme disease-follow up

Detailed Answer:
Hi,

Thank you for your query. I can understand your concerns.

In view of abnormal results in CSF analyses (mild positive for lyme from the fluid) & low grade headache ,chronic neurologic involvement is evident.
Patients with neurologic involvement are most commonly treated with IV ceftriaxone for 14–28 days. Your son has been given adequate oral therapy but symptoms persist.Hence parenteral antibiotic therapy is justified.He may have to be treated as in-patient for that purpose.
His SGOT & SGPT levels are normal.
Indication of mepron(atovaquone) is not clear and mepron can cause elevated liver enzymes.
Resbid (N-Acetyl-L-Cysteine) is hepatoprotective and Florastor as probiotic are adequate supportive therapy.




Regards

Dr. T.K. Biswas M.D. XXXXXXX
     
Hit thanks if it helps

Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Tushar Kanti Biswas (2 hours later)
Dear Dr. Biswas,

Thank you so much for your answer. You have been the most helpful so far. Because of his elevated liver enzymes and yellowish eyes, should he just stop the mepron and keep taking the doxycycline? Or just stop the oral therapy for now and see about the next step for IV treatment? Would he need to be admitted into the hospital for 14-28 days or can he go to the hospital for the IV treatment and then return home each day? Do you know if any hospital can give that type of treatment? There is one there in Elkins, WV, where he goes to school. Thank you again for your help as we try to figure out what we should do next to help our son.
XXXXXXX
doctor
Answered by Dr. Tushar Kanti Biswas (4 hours later)
Brief Answer:
Lyme disease-follow up

Detailed Answer:
Hi,

Thank you for your query. I can understand your concerns.
Parenteral antibiotic therapy with IV ceftriaxone seems indicated.It can be given as day care therapy ,provided he takes care of IV canula/port and hence outdoor sports activity may have to remain suspended for about 04 weeks. Oral therapy including mepron can be stopped once parenteral antibiotic therapy is initiated.







Regards

Dr. T.K. Biswas M.D. XXXXXXX
Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..

Above answer was peer-reviewed by : Dr. Raju A.T
doctor
Answered by
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Dr. Tushar Kanti Biswas

Internal Medicine Specialist

Practicing since :1975

Answered : 1920 Questions

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What Causes Yellowing Of White Part Of Eye In A Patient With Lyme Disease?

Brief Answer: Lyme disease Detailed Answer: Hi, Thank you for your query. I can understand your concerns. Lyme Disease can cause hepatitis. Yellow sclera of eyes is due to jaundice. However serum blirubin 2.2 mg/dl indicates mild jaundice. Let me know his SGOT & SGPT levels ,if done as part of liver function tests. Azithromycin sometimes can cause cholestatic jaundice. Doxycycline however is free of hepatic side effects. Despite treatment of the infection with antibiotic therapy, a small percentage of patients may have fatigue symptoms for months . Your son is however getting standard antibiotic therapy for Lyme disease ie doxycycline & azithromycin. For patients with disseminated infection, a 21-day course is usually recommended. Intravenous administration of ceftriaxone is sometimes recommended in late infections. Regards Dr. T.K. Biswas M.D. XXXXXXX Hit thanks if it helps