Answers To Case 23 Lyme Disease

Summary: A young man presents with a peripheral facial nerve palsy occurring in the setting of a febrile illness associated with arthralgias, myalgias, neck stiffness, and an erythematous annular plaque at his waistline. He recently went on a camping trip, but he shows no specific tick or other arthropod exposure. The rash is consistent with erythema migrans, the distinctive lesion of early Lyme disease, and all of the clinical features are consistent with that disease.

^ Most likely diagnosis: Lyme disease, probably early disseminated stage.

^ Most appropriate next step: Lumbar puncture to evaluate for meningitis and look for antibody production against Borrelia burgdorferi.

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