title: Delayed diagnosis of neuroborreliosis presenting as bell palsy and meningitis.
abstract: Lyme disease is most prevalent in the northeast and upper Midwest regions of the United States. While early symptoms may be mild (eg, rash, flu-like symptoms, joint pain), late or persistent infection can cause chronic neurologic impairments. Because of this range of symptoms, physicians can have difficulty diagnosing Lyme disease, especially in the absence of erythema chronicum migrans. We report a case of a woman who initially presented with severe vertigo and vomiting and later with fever, headache, and facial droop. After more than 3 weeks of misdiagnosis, the patient tested positive for Lyme disease and was diagnosed as having neuroborreliosis presenting as Bell palsy and meningitis. The authors review the history, diagnosis, and management of Lyme disease.
authors.affiliation: department of internal medicine at Sharon Hospital in Sharon, Connecticut, USA. imdocsmith@yahoo.com
authors.forename: Irving Shelby
authors.initials: IS
authors.lastname: Smith
authors.forename: David P
authors.initials: DP
authors.lastname: Rechlin
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D020330:Bell Palsy / Q000175:diagnosis* / Q000209:etiology; D002406:Catheterization, Peripheral; D002443:Ceftriaxone / Q000627:therapeutic use; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D020852:Lyme Neuroborreliosis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D008581:Meningitis / Q000175:diagnosis* / Q000209:etiology; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents; D005938:Glucocorticoids; D002443:Ceftriaxone; D011241:Prednisone