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Tuesday, October 27, 2009

A second opinion

A 36 year woman recently requested a second opinion after a recent diagnosis of MS.

She reported a history of tick bite. A Lyme WB from Labcorp revealed positive bands: IgG 41 and IgM 23. She was told her test results excluded Lyme in the differential.

One month prior to our visit she complained of numbness in her left upper and lower extremities. She also reported some stiffness in her neck.

Other symptoms were discounted: flu like symptoms with sweats and low grade fevers, swollen glands, joint swelling and pain and fatigue. Additional history revealed Bell's Palsy 15 years ago, heart palpitations and irritability. She initially denied all cognitive symptoms, only after further questioning she did admit to some progressive memory loss of the preceding two years.

An MRI revealed 4 white matter lesions in the brain and one in the cervical spinal cord.

The radiology report: "....demyelination due to multiple sclerosis or Lyme disease." This report was not from a radiology source which is familiar with my work.

As part of the MS work up the neurologist did an LP (spinal tap). I asked her to send a specimen to Clongen for PCR.

A report came to my desk amongst the usual pile of of daily lab reports and various requests.
This one caught my eye. Her spinal fluid was PCR positive for Lyme.

I called back to the office right away.
Her lab result and her appearance were incongruent. She sat across from me smiling, in no distress, appearing healthy in a casual glance.

This patient had Lyme in her spinal fluid. She had lesions in her brain.
She felt minimally ill and looked remarkably well. Of course I started IV Rocephin immediately.

During our most recent visit she told me she had seen "Under Our Skin."
She asked me: "How comes I am not sick like those people with Lyme?"


glytzhkof said...

I recognize some of this - I think it might be a classic case of someone having been sick for a long time and learned to sort of cope with it.

In times with plenty of sleep, good nutrition and little stress it is possible to feel relatively OK for a little while - even for a Lyme sufferer, and then you crash badly again when an immune-lowering event occurs.

I have lost count of how many times that's happened to me. The only thing that's certain is that Lyme never goes away on its own.

Momcat1011 said...

The data from this patient suggests that WB is not useful in diagnosing Lyme disease. Where there any presentations on PCR sampling?

Kara said...

Because she is blessed, that's why! Her strain may have something to do with it as well. But the bottom line is, she IS sick. She's just not dysfunctional at this point and has learned to cope.

I had Lyme 17 years before being diagnosed ... was dysfunctional 4 years prior to diagnosis. If you had told me I had Lyme 10 years into the infection, my jaw would've surely dropped. But, boy oh boy would I be so grateful at this point!

She is very blessed indeed! Here's hoping for a "quick and speedy" recovery as "Lyme time!"

Unknown said...

i was tested for lyme a few moths back and the results came back saying that it was reactive for 41 KD IGG...

can you tell me what this means...if i am understanding this right you need to have more than one reactive band to be positive? if that is true then what does a positive 41 KD mean alone?

i have some s/s that may be characteristic of lyme. This has been a troubling issue for years and Im trying to get any help that i could.

thanks so much!