Ent With Knee Pain

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Ent With Knee Pain - Page #4

Working Diagnosis: Lyme Arthritis of the Left knee Treatment: Started on Doxycycline 100mg BID x 28 days. Outcome: Patient had slow response to treatment and return to activity and returned to clinic after completing Doxycycline with only limited response to treatment. He stated symptoms worsened after antibiotics completed. It was discussed with patient that Lyme arthritis is an inflammatory disease and response may be slow. He was then started on Ibuprofen 600mg every 8 hours. Repeat MRI showed small knee effusion with synovial thickening and small Baker's cyst suspicious for inflammatory process. Ultrasound guided aspiration of left knee showed negative synovial fluid for Lyme DNA PCR. Patient gradually started to notice improvement in symptoms. He has started to increase activity and returned to biking. Author's Comments: Lyme disease is a tick-borne disease spread by Borrelia Burgdorferi. It is the most common tick-borne disease in North America and endemic to Michigan. Clinical manifestations may vary from erythema migrans rash, cardiac manifestations and/or neurologic infections and arthritis. Lyme ELISA (sensitive test) was positive. Confirmatory immunoblot (specific test) was positive for IgM (early) but negative for IgG (late). C6 peptide for Lyme was positive. C6 peptide has been shown to be 90-100% specific for B. Burgdorferi. Some patients may be symptomatic for years. Patients are unlikely to have cartilage erosion if treated and can participate in activities as tolerated. References: Arvikar SL, Steere AC. Diagnosis and treatment of Lyme arthritis. Infect Dis Clin North Am. 2015;29(2):269-80. Return To The Case Studies List.		Back
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