Lyme disease

Patient Presentation:
E.K., a 54 year old male presented with heat exhaustion symptoms following yard work on July 4th weekend of 95-100 degree days.  Patient felt lethargic, nauseous, had chills and diarrhea.  After significant rehydration with water and electrolyte drinks patient began to feel better.  One week later, the patient once again had flu-like symptoms, including chills that were unbearable.  Patient presented to primary care office, which stated summer flu was going around, but drew blood work and he was sent home.  In the next two weeks he continued to experience odd symptoms in cyclic fashion including, muscle pain and spasms, severe lethargy, headaches, fever, vision changes, severe dizziness and loss of balance as well as groin pain.  Within this three week period, the patient had days when he felt completely normal and days when he could barely get out of bed.

Differential Diagnosis:
The patient researched potential causes of illness online and discussed his symptoms with the primary care physician’s nurse.  The patient had multiple blood tests done and there was a potential that he could be experiencing a severe form of the flu, Lyme disease, cancer, multiple sclerosis, fibromyalgia or even meningitis.

Diagnosis/Prognosis:
Through his research and discussion with care givers this patient thought he could possibly have Lyme disease. He resides in Western Maryland and had been golfing the week before his symptoms began.  He remembered being in tall grassy areas, but also feared that he could have been bitten by an infected tick many years before.  Lab results were relatively normal other than a slight increase in his white blood cell count. Lyme disease is usually diagnosed based on symptoms and patient history.  Blood tests specific for Lyme disease measure antibodies in the blood but take several weeks for a positive result to appear, often people with Lyme disease do not have a positive blood test unless they have been suffering from symptoms for months to years.  This patient’s ELISA for Lyme disease test was negative.  The primary care physician believed that this patient was suffering from an acute episode of Lyme disease and was probably bitten in the previous three weeks when symptoms began.

Treatment:
The patient began a 21 day course of doxycycline 100mg PO b.i.d., as well as anti-inflammatory medications for continued muscle pain.

Outcome:
The patient completed the antibiotic course and followed up with his primary care physician.  He reported an additional two weeks of symptoms during treatment before he began to feel better. It was believed that since the patient was treated relatively quickly following the tick bite, that the antigens were quickly cleared from the bloodstream and the patient would feel no long term effects from the Lyme disease.
Case created by Erica Kunkel, 2011.