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Clinical Crossroads Update
December 24/31, 2003

A 58-Year-Old Man With a Diagnosis of Chronic Lyme Disease, 1 Year Later

JAMA. 2003;290(24):3247. doi:10.1001/jama.290.24.3247

At Internal Medicine Grand Rounds on February 14, 2002, Allen C. Steere, MD, discussed a 58-year-old man with chronic Lyme disease.1 The patient, Mr C, described 10 years of symptoms following spending time on Martha's Vineyard, an area endemic for Lyme disease. He reported an episode of left-sided Bell's palsy and subsequently noted that he was less competent mentally and that he had developed numerous physical symptoms including neck pain, back pain, joint aches, periodic blurred vision, and periodic sweats. He was treated for Lyme disease with an initial course of tetracycline and his symptoms improved. However, his symptoms returned a few years later, and he received multiple subsequent courses of antibiotics for Lyme disease. In late 1999, due to a change in his insurance, Mr C transferred to a new primary care physician, Dr N. His new physician was not convinced of the benefit of recurrent courses of antibiotics and wondered whether Mr C was suffering from depression. He prescribed paroxetine, 20 mg/d. On that regimen, Mr C noted less anxiety, less joint pain, and improved cognition. He was also sleeping better.

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