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Laboratory Value Normal Values Emergency Room Visit (9/8/2008) First Office Visit (9/9/2008) Second Office Visit (9/16/2008) White blood cell count (thousand/cumm) 4.5–10.5 4.6 3.7 6.8 Lymphocyte (%) 13.0–43.0 27.2 45.6 23 Aspartate aminotransferase (u/l) 5.0–40.0 74 119 34 Total creatine kinase (u/l) 20–235 1957 2672 156 C-reactive protein (mg/dL) <0.50 1.13 0.06 Lactate dehydrogenase (u/l) 50 to 200 227 170 Hepatitis B virus surface antigen Negative Negative Hepatitis C virus antibody Negative Negative Rheumatoid factor Negative Negative Lyme antibody screen (Lyme Index value) <1.00 1.24 1.7 Lyme antibody, IgG, Western Blot Negative Positive Parvovirus B19 IgG antibody <0.89 4.12 Parvovirus B19 IgM antibody Negative Negative Epstein-Barr virus IgG antibody <1.20 1.20 Epstein-Barr virus IgM antibody Negative Negative IgG, immunoglobulin G; IgM, immunoglobulin M.
Date Event September 4 Symptom onset September 5 Urgent care visit; 3-day amoxicillin course started September 8 Visit to emergency department September 9 First office visit; Lyme titers #1 drawn; prednisone started September 16 Second office visit; patient symptomatically improved; Lyme titers #2 drawn; doxycycline started September 17 Lyme titers #1 return positive September 23 Lyme titers #2 return positive, higher Lyme Index value
