From Prominent Pain Management (PPM)
“Immunosuppression secondary to epidural steroid injection (ESI) is a well-documented adverse effect in the medical literature. Reports of systemic effects of immunosuppression resulting from corticosteroid dosages given by ESIs are anecdotal at best. This case report discusses the activation of latent Lyme disease following a lumbar ESI.”
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Antibiotics and Steroids
From: Lyme Disease 1991: Patient/Physician Perspectives from the U.S. and Canada Lora Mermin, editor by John Drulle, M.D.
“It is interesting to note that in dogs who had Lyme disease, injections of dexamethasone, a corticosteroid, enabled Borrelia burgdorferi to be cultured from blood drawn on the following day. This was done by Dr. Elizabeth Burgess at the University of Wisconsin. This suggests that the steroid suppresses a mechanism for keeping the bacteria out of the circulatory system, since ordinarily it is difficult to grow the Lyme organism from the blood. Entrance of the bacteria into the bloodstream can allow seeding of other organs.I have used steroids in Lyme patients, but only in very selected circumstances. In patients who have presented with eye involvement with rapidly deteriorating vision, such as optic neuritis or uveitis, the combination of high dose steroids appears to restore vision more rapidly than by using antibiotics alone. I have also used steroids in combination with antibiotics in patients who presented with a Lyme induced polymyalgia rheumatica (PMR). “PMR is a common disease of elderly people characterized by pain and stiffness in the muscles of the upper arms and legs, fevers, malaise and weight loss. The ESR, sedimentation rate is elevated. In its classic form, the cause of the condition is unknown, and the dramatic response to steroids is in itself diagnostic. I have personally seen three cases of Lyme induced PMR, which did not respond to steroids alone or antibiotics alone, yet when the combination was given the response was dramatic. In conclusion, the decision to use the steroids in a Lyme patient must be given considerable thought and the possible benefits must be weighed against the risks. I would not use steroids unless the patient was also on antibiotics.”
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