To the Editor.
—The article by Drs Feder and Hunt1 will serve as a good reminder that the misdiagnosis of Lyme disease is not merely a problem in adults.However, although it is true that in later features of Lyme disease (eg, arthritis or tertiary neuroborreliosis) patients are usually seropositive, it is possible for a patient to have early disseminated Lyme disease (eg, carditis, meningitis, peripheral neuropathy, or facial palsy) and be seronegative.2 If a patient has features suggestive of early Lyme disease and is seronegative on enzyme-linked immunosorbent assay (ELISA), one may detect serum antibodies by immunoblot or by cerebrospinal fluid evidence of immunoreactivity in the absence of measurable serum antibodies.3 In patients with the earliest features of Lyme disease, the diagnosis may be made despite seronegativity.The authors point out that Lyme disease can be misdiagnosed in patients with neurologic, rheumatologic, and cardiac complaints in
Sigal LH. Diagnosis of Lyme Disease. JAMA. 1995;274(18):1427. doi:10.1001/jama.1995.03530180021020