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Lyme Disease Self Assessment

Question 5

A 40-year-old woman comes to the office for evaluation of a rash on her left thigh. At first it looked to her like an insect bite, but over the past week, it has been getting larger. The rash is neither itchy nor painful. She has also noticed a mild headache. She denies fever, chills, other skin lesions, and respiratory, gastrointestinal, or musculoskeletal symptoms. She has no significant medical or surgical history. She is employed as a landscaper in the Philadelphia suburbs. She has been taking acetaminophen for her headache, with good relief of symptoms. She has been on no other medication and has no medication allergies.

On physical examination, her temperature is 37.8 C (100 F). Her other vital signs are normal. Skin examination is notable for a single, 6-cm, erythematous, circular macular patch with partial clearing near its center on her left thigh, just below her groin, that is slightly painful to palpation. Her physical examination is otherwise normal. Complete blood count is normal, and results of total and IgM Lyme titers are pending.

What would you do next?

(A) If IgM Lyme titer is positive, begin treatment with amoxicillin
(B) Begin treatment with amoxicillin now, and discontinue if Lyme titers are negative
(C) Begin amoxicillin now, and continue for 3 weeks regardless of results of initial Lyme titers
(D) If IgM Lyme titer is negative now, repeat in 2 weeks, and treat with amoxicillin then if positive

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