Hiccups and Inappropriate ADH Secretion Syndrome as Presentations of Tick-Borne Disease

Tick-borne diseases (Lyme disease and tick-borne encephalitis) are becoming a major public health concern. Rapid and correct diagnosis is crucial for complicated cases but is often delayed because of low suspicion or unusual clinical presentation. In this paper the authors describe two atypical presentations of Lyme disease and tick-borne encephalitis in order to help clinicians resolve diagnostic challenges. LEARNING POINTS: Tick -borne diseases canould have atypical presentations. In endemic areas, patients with unexplained and refractory hyponatremiaaemia, should be screened for Lyme disease even in the absence of elevatedion of inflammatory markers or other specific symptoms. Persistent hiccups could be an atypical clinical presentation of tick-borne encephalitis (TBE).