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Borreliosis (Lyme Disease)

Clinical Cases

Case 1

  • 14-year-old teenage girl with a rash on the right lateral cheek present for four days
  • Skin lesion developed three days after a hike through the woods
  • No known history of tick bites
  • Otherwise healthy, feeling well

Initial evaluation

  • Exam reveals a 7 cm annular erythematous, urticarial plaque consistent with erythema chronicum migrans
  • No tick bites noted
  • Review of systems does not indicate any ocular, joint, cardiac, or neurologic symptoms
  • Recommend doxycycline 100 mg p.o. b.i.d. for 10 days
  • Follow-up in one month

One-month follow-up evaluation

  • Skin lesion now resolved
  • Review of systems does not indicate any ocular, joint, cardiac, or neurologic symptoms
  • Follow-up in three months as part of ongoing monitoring for development of symptoms and signs of disseminated infection

Three-month follow-up evaluation

  • No evidence of disseminated infection noted

Case 2

  • 18-year-old male presents with new onset unilateral facial palsy
  • History of a tick bite that occurred while camping several months prior to presentation, with development of an annular, erythematous, urticarial plaque at the site of the tick bite (suggestive of erythema chronicum migrans)
  • Otherwise healthy
  • Denies joint, cardiac, ocular, or additional neurologic symptoms

Initial evaluation

  • Reveals no skin lesions
  • Neurologic exam notable only for unilateral facial palsy
  • Electrocardiography performed in clinic is normal
  • Blood testing notable for (+) Lyme antibodies by ELISA
  • Diagnosis of Lyme-related facial palsy
  • Doxycycline 100 mg p.o. b.i.d. for 21 days

One-month follow-up evaluation

  • Denies joint, cardiac, ocular, or new neurologic symptoms
  • Facial palsy improving
  • Repeat neurologic exam is otherwise normal
  • Follow-up in one month