Aucott John N, Seifter Ari
Johns Hopkins Greenspring Station, Lutherville, MD, USA.
Orthop Rev (Pavia). 2011;3(2):e14. doi: 10.4081/or.2011.e14. Epub 2011 Jun 29.
Lyme disease is often identified by the hallmark erythema migrans rash, but not all early cases present with a rash. In other cases the rash may be unseen or unrecognized by a physician. In these situations, Lyme disease is difficult to diagnose because it masquerades as a non-specific viral-like illness. The seasonal peak of Lyme disease ranging from May through September overlaps with that of viral illnesses such as enteroviral infections, West Nile virus, and in rare years such as 2009, early influenza season. We present a case of a patient with Lyme disease who was initially misdiagnosed with influenza A during the summer of 2009. Because of the diagnostic importance of recognizing the erythema migrans rash, physicians in endemic regions should always ask about new rashes or skin lesions and perform a thorough physical examination when patients present over the summer with viral-like symptoms. Even when no rash is evident, Lyme disease should be considered if these symptoms persist or worsen without a specific diagnosis.
莱姆病通常通过标志性的游走性红斑皮疹来确诊，但并非所有早期病例都会出现皮疹。在其他情况下，皮疹可能未被医生发现或识别。在这些情况下，莱姆病很难诊断，因为它伪装成一种非特异性的类似病毒的疾病。莱姆病的季节性高峰在5月至9月，与肠道病毒感染、西尼罗河病毒等病毒性疾病的高峰重叠，在2009年等罕见年份，还与早期流感季节重叠。我们报告一例2009年夏季最初被误诊为甲型流感的莱姆病患者。由于认识游走性红斑皮疹对诊断很重要，流行地区的医生在夏季患者出现类似病毒症状时，应始终询问是否有新的皮疹或皮肤病变，并进行全面的体格检查。即使没有明显的皮疹，如果这些症状持续或在没有明确诊断的情况下恶化，也应考虑莱姆病。
