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Case Reports in Infectious Diseases
Volume 2017 (2017), Article ID 6598043, 5 pages
https://doi.org/10.1155/2017/6598043
Case Report

A Case of Early Disseminated Neurological Lyme Disease Followed by Atypical Cutaneous Manifestations

Department of Internal Medicine, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA, USA

Correspondence should be addressed to Vamsi Kantamaneni; moc.liamg@748.ismav

Received 8 February 2017; Revised 26 March 2017; Accepted 3 April 2017; Published 23 April 2017

Academic Editor: Sinésio Talhari

Copyright © 2017 Vamsi Kantamaneni et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Lyme disease (LD) is a tick-borne illness caused by Borrelia burgdorferi sensu stricto. An 80-year-old female from Pennsylvania, USA, presented to an outside hospital with fever, confusion, lower extremity weakness, and stool incontinence. CT head and MRI spine were unremarkable. An infectious work-up including lumbar puncture was negative. She was transferred to our tertiary care hospital. Patient was noted to have mild unilateral right-sided facial droop and a diffuse macular rash throughout the body. She denied any outdoor activities, tick bites, or previous rash. Intravenous ceftriaxone was started for suspected LD. The patient’s symptoms including facial droop resolved within 24 hours of antibiotic therapy. Polymerase chain reaction of the blood, IgM ELISA, and IgM Western blot testing for LD came back positive a few days after initiation of therapy. She was treated for a total of 21 days for neurological LD with complete symptom resolution. Not all patients have the classic “targetoid” EM rash on initial presentation, rash could develop after neurological manifestations, and prompt initiation of antibiotics without awaiting serology is paramount to making a quick and a full recovery. There should be a high index of suspicion for early disseminated LD, as presentations can be atypical.