An Unusual Presentation of Lyme Disease: A Case Report

Abstract

We present this case of a 67-year-old female with a background of Type 2 Diabetes Mellitus and Hypercholesterolaemia, who presented with a one day history of acute confusion, a facial rash, one episode of urinary incontinence, a fever and sweating. On examination there was an erythematous rash on both cheeks and across the nose, which later became crusted and well demarcated. The vital signs showed she had a fever, the remaining signs were normal. The white cell count was 16 x109/L and CRP 11 mg/L. An auto-antibody screen, CSF microbiology and culture sample and viral CSF PCR screen were unremarkable. On further history taking it was noted that she spent a considerable amount of time in the garden, and that three weeks ago she was bitten by a tick on the face whilst in the garden. Her relative had also had a left leg tick bite from the same garden, which resulted in a rash which resolved following treatment with Doxycycline. A diagnosis of Lyme Disease was made, and her symptoms improved with a course of Doxycycline. This case presentation highlights the variability in which patients with Lyme disease can present, leading to diagnostic complexity, and how history taking was key to reaching a diagnosis.