A case revealing the natural history of untreated Lyme disease – Source: Nature Reviews Rheumatology, Dec 21, 2010

[Note: Specialists at Yale estimate that 60% of people who do not receive antibiotic treatment soon after infection with Lyme go on to develop Lyme arthritis; an inflammation of the lining of one or more joints caused by the Lyme spirochete.]

Background: A 71-year-old woman presented to a rheumatologist with what she believed to be a 2-year history of Lyme disease, progressing from erythema migrans [rash] to Lyme arthritis.

Investigations: History, physical examination and serologic testing confirmed the diagnosis of Lyme disease.

Management:

The patient refused antibiotic therapy during the first 2 years of her illness.

During the next 2 years, she consulted a rheumatologist, but declined antibiotic therapy.

She continued to have recurrent episodes of arthritis, following which she was successfully treated with doxycycline, given initially for 2 weeks, with a second, 4-week cycle administered 2 months later.

This case illustrates the natural history of untreated Lyme disease, which is rarely observed in most patients since diagnosis almost always leads to successful antibiotic treatment.

Furthermore, this case also demonstrates that infection with Borrelia burgdorferi can persist for years in untreated patients; however, antibiotic therapy is still likely to be effective, despite long-term infection.

Source: Nature Reviews Rheumatology, Dec 21, 2010. PMID: 21173795, by Schoen RT. Section of Rheumatology, Yale University School of Medicine, New Haven, Connecticut, USA. [Email: Robert.schoen@yale.edu]

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