Lyme disease is first undiagnosed, then properly diagnosed, and then almost improperly overtreated.
In 2021 a 60-year-old man from rural NY developed a swollen knee while wintering in Florida; he was diagnosed as having “pseudogout” in his knee by a Florida rheumatologist, though the fluid taken from his joint didn’t confirm this diagnosis. He returned to NY and when his knee swelled again, he was diagnosed correctly with late-stage Lyme arthritis and treated with one month of antibiotics. Over 6 weeks his knee pain and swelling completely resolved.
Two months later a bursa pouch over his elbow swelled and without further testing, his rheumatologist told him that his Lyme disease had returned and to start 4 weeks of intravenous antibiotics. He sought my evaluation; I recommended that he have fluid removal from the bursa to be analyzed; this suggested this was not Lyme disease; it has since resolved with no further treatment and he remains well.
The Lyme Disease Expert’s Analysis:
The first rheumatologist neglected to get a travel history and didn’t even consider Lyme disease. (significant error) The second rheumatologist made a correct diagnosis and chose the appropriate treatment; however, when a new problem occurred, because of the past history of Lyme disease, an expensive and potentially harmful intravenous treatment was almost started without reinvestigating the new problem.
Outcome:
The patient has recovered and remains well
Teaching Lesson:
In patients who have had Lyme disease, there is a temptation to blame all future illnesses on Lyme disease, rather than re-investigating them.
Patient Followup Testimonial:
“I was referred to Dr. Luger for a consultation who was described to me as a leading authority on Lyme disease. I was seen promptly and within a few minutes recognized that he is, in fact, everything my friend described him to be and much more. Not only did he spend quality, unhurried time explaining my condition leading to a course of action but he did it in the most professional, informative, and sensitive manner that anyone could hope for. His expertise and a vast amount of experience were evident in that he changed the course I was recommended which would have led to an undesirable intravenous treatment. I am thankful to Dr. Luger and know that I am in good hands as I continue to be advised by the very best.”
