METHODS: Second Presentation
A second set of lab studies was obtained, similar to the one obtained
the day before except for the platelet count returning to normal at
145x1000/uL (Table 1). By this time his tickborne panel had fully
resulted with positive Lyme antibodies on Enzyme linked immunosorbent
assay (ELISA) screen, but negative IgM and IgG on the western blot
reflex (Table 1). A second sample was drawn at the time, which resulted
in positive IgM and negative IgG (Table 1). Due to the concern for
meningitis, a lumbar puncture was performed with the opening pressure
measured as normal. The cerebrospinal fluid (CSF) was sent for analysis
and culture, resulting in a CSF glucose of 65mg/dL (normal), a CSF
protein of 26.7mg/dL (normal), and no culture growth (Table 1). Given
that he was well-appearing, the cultures could be followed outpatient.
He was discharged with a course of 60mg of prednisone daily for 10 days
for the Bell’s palsy and precautions to tape his right eye shut while
sleeping, and instructions to extend the course of his doxycycline from
10 to 21 days since he was now being treated for presumed neurologic
Lyme disease rather than uncomplicated Lyme disease.