A 27-year old white female presented at the walking clinic of her local physician on August 15. On physical exam, the patient ha
d a fever of 38.5C. She appeared fatigued, had tender joints, and complained of a headache, a stiff neck and a backache. The physician noticed a circular "rash" about 5 inches in diameter, with a bright red leading edge and a dim center in the form of a "bull’s eye". The physician noted an irregular heartbeat. The patient complained of lack of ability to concentrate. The patient gave the following history: She is a graduate student in the wildlife program at the university in town. She was in the field for three weeks in Wisconsin during the months of May and June. She tracks small mammals in the field and studies their behavior. It had been a warm, wet spring and she complained of a large number of biting flies, mosquitoes and ticks in the area. She felt well until about 2 weeks after returning to her home. Since that time, many of her symptoms had progressed. She finally found that she could take it no more. 1. What is your best diagnosis of this case? 2. What features are critical to your diagnosis? 3. What further steps should be taken to clear up the problem?
The best diagnosis of this case is lymes disease. The ring with the bullseye and the wildlife training in a heavily wooded state in early summer are the lead factors. The doctor should prescribe the correct dosage of the steroid that keeps this disease at bay for the rest of her life.
