I had a hellacious day. Lyme patients out the wazoo. I apologized to a patient who had been waiting for over an hour. I told him the previous patient was "famous."
He said: "Hey, don't I rate?" I thought about it for a minute and told him I would write about his interesting case.
This 66 year old gentleman came to me first on September 5, 2008. He had just come back from New Jersey. He complained of an acute flu like syndrome with muscle pain, headache, neck pain,weakness, fever, chills and drenching sweats. The symptoms were occurring in 3 day cycles. His physical exam showed no obvious focus of infection. Of course I thought "ah ha" Babesia.
I started him right on Mepron and Biaxin. He saw me again on September 23. The sweats and chills were 100% gone. Now he had red cutaneous nodules and heel pain. "Ah ha." Bartonella.
I switched him to Cipro and Doxycyline.
Today I saw him again. The heel pain and nodules were gone. Now he felt tired and achy. "Now," I thought: "Typical Lyme." I looked at his labs. Standard co-infection panel negative. Lyme WB by IgeneX: IgM IND 41 band only, IgG 41 band ++, 31,34 and 39 bands-all IND.
"Looks like old Lyme." I scratched my head. Many patients have new infections which seem to activate old disease. In this case I suspect he had a fresh Ixodes bite injecting him with new Lyme and new co-infections. Now he was experiencing symptoms of typical chronic Lyme. The expression "let sleeping dogs lay" csmr to mind. It looks like the new exposure had kicked him into chronic Lyme mode. I prescribed Amoxil, Biaxin and Plaquenil and asked him to return in one month. This is an interesting presentation.
Every case is different.
Yes: it is Lyme disease. Not :Lymes disease. Many make this mistake. So what?
From high school lit: "A rose by any other name would smell as sweet."