RT Journal Article SR Electronic T1 Unusual Presentation of Lyme Disease: Horner Syndrome with Negative Serology JF The Journal of the American Board of Family Medicine JO J Am Board Fam Med FD American Board of Family Medicine SP 219 OP 222 DO 10.3122/jabfm.2009.02.080130 VO 22 IS 2 A1 Candis Morrison A1 Ari Seifter A1 John N. Aucott YR 2009 UL http://www.jabfm.org/content/22/2/219.abstract 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.