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Lyme Disease Self Assessment

Question 4

A 34-year-old white woman from Nantucket, Massachusetts, develops constitutional symptoms and mild swelling in her left inguinal area. Physical examination reveals lymphadenopathy and a few mild skin abrasions over her lower leg. No lesions of erythema chronicum migrans are seen, and the patient cannot remember obvious tick exposure. The symptoms resolve spontaneously without therapy.

Approximately 6 weeks later, she develops migratory polyarthralgia, sore throat, left facial palsy, and headache. Physical examination reveals normal vital signs, normal cardiopulmonary examination with regular rate and rhythm, no evidence of arthritis, and a peripheral facial cranial neuropathy. Laboratory analysis is normal, except for mild elevation of serum aminotransferase levels. Rheumatoid factor is positive in a titer of 1:64. Analysis of cerebrospinal fluid reveals mild pleocytosis and a protein level of 80 mg/dL, and a computed tomographic scan is normal. An enzyme-linked immunosorbent assay (ELISA) for antibody to Borrelia burgdorferi is positive.

The most appropriate therapy for this patient is:

(A) Oral penicillin
(B) Doxycycline
(C) Intravenous ceftriaxone
(D) High-dose parenteral glucocorticoids
(E) None of the above

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