Summary
This case study describes an African-American male who was misdiagnosed for 7 weeks despite the patient exhibiting common symptoms and signs of Lyme disease (including EM rash and facial palsy). Misdiagnoses led to delays in effective therapy and worsening of symptoms. This case supports other research findings showing patients with a delayed initial diagnosis, more numerous or more severe initial symptoms, or neurologic involvement are at a higher risk for developing persistent symptoms of Lyme disease. The case also reveals that EM rash, when present, may be harder to discern in people of color.
Why was this study done?
Overall, few studies have sought to investigate whether racial or other demographic factors influence patient care or outcomes in Lyme disease. This study aims to improve provider awareness of Lyme disease risk factors and racial differences in diagnostic findings such as the skin rash and could help improve early diagnosis and reduce risk of persistent symptoms.
How was this study done?
This case study depicts an African-American man in his 30s who despite several medical evaluations and treatments was misdiagnosed for 7 weeks before ultimately being diagnosed and treated for Lyme disease with seventh nerve palsy and meningitis. The study captures his health history, including early symptoms and signs of disseminated infection, misdiagnosis, treatment, and persistent symptoms following initial treatment. The case reveals gaps in physician recognition of early signs of Lyme disease and possible racial differences in diagnostic findings.
What were the major findings?
Despite the patient exhibiting common signs and symptoms of early Lyme disease (including an EM rash, fever, chills, fatigue) and later disseminated neurologic Lyme disease manifestations (including facial palsy, leg numbness, neck pain, headache, meningitis) he was misdiagnosed for 7 weeks leading to delays in effective therapy and worsening of symptoms. The patient’s symptoms did not fully resolve after aggressive treatment and continued to negatively impact his quality of life.
The case study supports the finding that in Lyme disease-endemic areas, African-American patients may be at higher risk for missed or late diagnosis.
Supporting Image
Lyme disease erythema migrans (EM) rash, right underarm
