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:
Search PIER® - Decision Support
ACP Members Only. Decision support for over 460 clinical topics.
Introducing ACP Clinical Shorts - Expert Education on Your Schedule
 |
|
10-minute videos give you answers to challenging clinical dilemmas seen in practice and are a terrific way to earn CME credit on-the-go. See more. |
ACP JournalWise: Reviews of the World's Top Medical Journals-FREE to ACP Members!
|
ACP JournalWise is mobile optimized with optional email alerts! Get access to reviews from over 120 of the world's top medical journals alerting you to the highest quality, most clinically relevant new articles based on your preferred areas of specialty. ACP Members register your FREE account now! |
