Lyme Disease

Quite Rash

Step 1: View clinicals

A 40 year old man presents with the inability to close both eyes, along with difficulty in speaking with drooling of saliva. There is no history of difficulty in swallowing or hearing, or of weakness elsewhere in the body. He presented a week ago with a unilateral facial nerve palsy. At that time he was reassured and then discharged on Acyclovir. Two weeks ago, he experienced a self-limited episode of fever, headache and myalgia which lasted for 3 days. He had returned from a trip to Pennsylvania immediately earlier. His medical, surgical and family histories are unremarkable. He is not any medications. A full blood count is found to be within normal parameters.


Step 2: Order all relevant investigations

CT Brain

No abnormalities detected.

Total Lyme Titre

Enzyme Immunoassay (EIA): positive Western blot: positive

Facial Nerve Biopsy

You realize that a facial nerve biopsy might not be a good idea.

Biopsy Lesion

You realize that a biopsy of the lesion is probably not indicated.


Step 3: Select appropriate management

Doxycycline
Acyclovir
Steroids
Plasmapheresis


Score: ★★☆