PT  - JOURNAL ARTICLE
AU  - Candis Morrison
AU  - Ari Seifter
AU  - John N. Aucott
TI  - Unusual Presentation of Lyme Disease: Horner Syndrome with Negative Serology
AID  - 10.3122/jabfm.2009.02.080130
DP  - 2009 Mar 01
TA  - The Journal of the American Board of Family
                Medicine
PG  - 219--222
VI  - 22
IP  - 2
4099  - http://www.jabfm.org/content/22/2/219.short
4100  - http://www.jabfm.org/content/22/2/219.full
SO  - J Am Board Fam Med2009 Mar 01; 22
AB  - Early disseminated Lyme disease can be difficult to diagnose because of atypical symptoms and physical findings. A clinical diagnosis must be made in the absence of confirmatory serologic testing to allow timely therapy. We report a case of a 69-year-old woman who presents with fever, Horner syndrome, and a 12-cm oval-shaped erythematous macular rash with multiple vesiculopustular eruptions. The patient recovered after appropriate intravenous antibiotics, but serologic testing only confirmed the diagnosis 4 weeks later. This case also describes an unusual complication involving the neurologic system. We illustrate the clinical presentation and review the medical literature. Lyme disease should always be considered in patients from endemic regions with viral-like symptoms or a new rash.