title: A case revealing the natural history of untreated Lyme disease.
abstract: BACKGROUND
  A 71-year-old woman presented to a rheumatologist with what she believed to be a 2-year history of Lyme disease, progressing from erythema migrans to Lyme arthritis.
  
  
  METHODS
  History, physical examination and serologic testing confirmed the diagnosis of Lyme disease.
  
  
  METHODS
  Lyme disease.
  
  
  RESULTS
  The patient refused antibiotic therapy during the first 2 years of her illness. During the next 2 years, she consulted a rheumatologist, but declined antibiotic therapy. She continued to have recurrent episodes of arthritis, following which she was successfully treated with doxycycline, given initially for 2 weeks, with a second, 4-week cycle administered 2 months later. This case illustrates the natural history of untreated Lyme disease, which is rarely observed in most patients since diagnosis almost always leads to successful antibiotic treatment. Furthermore, this case also demonstrates that infection with Borrelia burgdorferi can persist for years in untreated patients; however, antibiotic therapy is still likely to be effective, despite long-term infection.
authors.affiliation: Section of Rheumatology, Yale University School of Medicine, 60 Temple Street, New Haven, CT 06510, USA. robert.schoen@yale.edu
authors.forename: Robert T
authors.initials: RT
authors.lastname: Schoen
mesh_terms: D000368:Aged; D000658:Amoxicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D025065:Borrelia burgdorferi; D018450:Disease Progression; D004318:Doxycycline / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008193:Lyme Disease / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D000658:Amoxicillin; D004318:Doxycycline