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Lyme Disease Self Assessment

Question 3

A 45-year-old man from Cape Cod, Massachusetts, developed a slowing expanding erythematous lesion on his back. His physician declined to obtain serologic studies for Lyme disease but started treatment with doxycycline for 21 days, and the lesion quickly improved.

Two weeks later, the patient develops fevers, drenching night sweats, myalgias, and malaise. Other than a splenectomy 15 years ago following a motor vehicle accident, he is in good health and takes no medications.

On physical examination, temperature is 40.0 C (104.0 F). Pallor and pale conjunctivae are present. There is no lymphadenopathy. Heart rate is regular. A grade 2/6 systolic murmur is heard. The lungs are clear. The abdomen has a long midline surgical scar. Bowel sounds are normal. The liver is palpable 4 cm below the right costal margin in the midclavicular line. There is no palpable spleen.

Laboratory Studies
Hemoglobin 7.1 g/dL
Hematocrit 21%
Leukocyte count 4000/μL
Platelet count 50,000/μL
Serum haptoglobin 1 mg/dL
Serum aspartate aminotransferase 250 U/L
Serum alanine aminotransferase 150 U/L
Serum bilirubin 3.0 mg/dL
Serum alkaline phosphatase 375 U/L
Serum lactate dehydrogenase 575 U/L


Which of the following should be done next to establish the diagnosis?

(A) Serologic studies for Lyme disease
(B) Ehrlichia antibody titer
(C) Serologic studies for Rocky Mountain spotted fever
(D) Giemsa- or Wright-stained peripheral blood smear

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