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1998 Presentations for the Poster and Vignette Sessions
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TICK TALK: IT'S LYME TO GET GOING! Rhonda Heun, M.D., Gundersen Lutheran Medical Foundation, La Crosse, Wisconsin.

Lyme disease is relatively common in Wisconsin and the Midwest. It can often evade diagnosis, masquerade as other illnesses and present with protean, non­specific signs and symptoms that are easily compatible with multiple other diagnoses.

We present a fifty­four­year­old woman whose initial symptoms include severe, localized back pain, anorexia, and fevers. Eventually, she developed transaminase elevations most consistent with hepatitis. Thorough evaluation and testing revealed only acute infection with Borrelia burgdorferi. Treatment for Lyme disease was begun, and within days, her symptoms improved drastically, and gradually, her transaminases returned to normal.

Mild elevations in transaminase are common in certain infections, but transaminase elevations of this magnitude are not typically associated with Lyme disease. This case demonstrates multiple atypical features of Lyme disease and reminds clinicians that this diagnosis should be entertained in a wide variety of clinical scenarios.

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