Disseminated Lyme Disease
As a third-year family medicine resident, I often encounter confusing or atypical dermatologic conditions on a day-to-day basis. Recently, I admitted a 33-year-old man to the hospital who presented with several days of a diffuse rash and feeling miserable with fatigue, malaise, and sweats. He had scattered annular pink lesions measuring 2-5 cm in diameter over his entire body but sparing the face and hands. They didn't appear classic for any condition that I could remember off the top of my head. His initial work-up was negative for infectious causes, he had not traveled, and he had no new drugs or exposures that he was aware of. The team was stumped.
I used VisualDx to help develop a differential diagnosis based on the characteristics of the rash. The differential included erythema annulare, tinea corporis, Lyme disease, erythema multiforme, and lupus among several other causes. After more careful history taking, I became increasingly suspicious for early disseminated Lyme disease, as the patient lived in a Lyme-prevalent area and had spent time outside where he could have been exposed to ticks. We initiated antibiotics and ordered confirmatory testing. My attending had also consulted dermatology to help make the diagnosis and determine if a biopsy was necessary. I felt great because the dermatologist and the lab results confirmed my suspicion that this was Lyme disease. Thanks to VisualDx providing me real-time clinical information, I was able to make the proper diagnosis in a timely manner and get the patient on his way to a healthy recovery.
– Lincoln Heath, MD
Dr. Lincoln Heath is a third-year Family Medicine resident at the University of Vermont (UVM)/Fletcher Allen Healthcare in Burlington, VT. He completed his undergraduate training at the McGill University, Montreal, QC, and attended medical school at the UVM College of Medicine, where he was inducted into the Gold Humanism Honor Society. Dr. Heath has an interest in international and local refugee health, and has spent a significant amount of time in East Africa. He is happily married, and enjoys numerous hobbies and outdoor activities including rock climbing, ice hockey, hiking, and camping.