Dealing with a Mysterious Condition
Businessman on internaional trip airlifted to
bring him home and get treated
A 61 year old businessman was brought to Nanavati Super Speciality
Hospital, Mumbai with a history of high-grade fever, minor
breathlessness, debilitating joint pains associated with signifi cant
swelling for a few weeks. In the previous 30 days, the patient had been
travelling internationally to Paris and then to Sri Lanka for businessrelated
work. He developed the fi rst fever spike while in Paris and was
treated there on an OPD basis with only partial relief. A few days later,
he needed hospitalisation for recurrence of fever and breathlessness in
He was found to have normal CBC, elevated CRP, Atrial Fibrillation
and Left Bundle Branch Block (LBBB) with preserved Ejection
Fraction (EF) and interstitial shadows in both lung fi elds on CT chest.
He was investigated for Atypical Pneumonia, but no cause was found.
He did not respond to higher antibiotics, amiodarone and supportive
treatment and, hence, was airlifted to Mumbai after 4 days. The
patient was fi rst admitted to another tertiary care hospital in Mumbai
where he continued to have fever spikes and dyspnoea with signifi cant
worsening of joint pains.
As his fever and infective markers were worsening, his antibiotics
were stepped up to vancomycin and meropenem with no relief to his
symptoms. At this point, he was referred to Nanavati Super Speciality
Hospital with extensive investigations for pyrexia of unknown origin
that had not revealed any specific cause.
In view of his recent history of travel, recurrent fever spells, Cardiac
Arrhythmias and Oligoarticular Arthritis, a diagnosis of Lyme’s disease
was considered. His higher antibiotics were stopped and the patient
was put on Doxycycline. Simultaneously, his borrelia burgdorferi IgM
was obtained, which was strongly positive.
Within 2 to 3 days, the fever and synovitis showed signifi cant resolution
and the patient was discharged. The recovery was rather uneventful.
The patient was advised for a follow-up visit after two weeks. During
the follow-up, doctors observed no fever and joint pains even after
stopping the NSAIDs. The patient could resume his normal routine
without any diffi culty.