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.