Disulfiram (Antabuse) Neurotoxicity: Implications of Painful Small Fiber Sensory Polyneuropathy for Lyme Disease and Addiction

This article describes the prototypical clinical presentation, electrodiagnostic and neuropathological findings and treatment of a patient with painful peripheral neuropathy due to disulfiram toxicity. Although a review of the literature fails to reveal cases of painful peripheral neuropathy due to disulfiram toxicity, there has been heightened publicity of its risk in the treatment of persistent symptoms of Lyme disease following a standard of care course of antibiotics known as post-treatment Lyme disease syndrome. This article reviews the etiopathogenesis and diagnosis of predominant small fiber neuropathy resulting from disulfiram neurotoxicity, and offers recommendations for its use in Lyme disease and alcoholism.