Paparone P W
Lyme Disease Center for South Jersey, Absecon.
Postgrad Med. 1995 Jan;97(1):161-4, 167-70.
This case report demonstrates the need to consider Lyme disease in older patients who present with nonspecific signs and symptoms often seen in polymyalgia rheumatica, particularly a markedly elevated erythrocyte sedimentation rate (ESR). ESRs greater than 100 mm/hr are common in polymyalgia rheumatica, but rates higher than 85 mm/hr are also possible in Borrelia infection. Because positive serologic findings for Lyme disease have been noted in patients with polymyalgia rheumatica who have been exposed to endemic areas, differential diagnosis must be based on clinical manifestations. Response to therapy should be monitored closely to confirm the diagnosis and avoid the adverse consequences of inappropriate treatment. The potentially deleterious effect that corticosteroids can have on Lyme disease must be considered in the decision to treat polymyalgia rheumatica.
本病例报告表明，对于出现多肌痛常见的非特异性体征和症状的老年患者，尤其是红细胞沉降率（ESR）显著升高的患者，需要考虑莱姆病。ESR大于100mm/hr在多肌痛中很常见，但在伯氏疏螺旋体感染中，ESR高于85mm/hr也有可能。由于在接触过流行地区的多肌痛患者中已发现莱姆病血清学检查呈阳性，因此鉴别诊断必须基于临床表现。应密切监测对治疗的反应，以确诊并避免不适当治疗的不良后果。在决定治疗多肌痛时，必须考虑皮质类固醇对莱姆病可能产生的有害影响。
