A 45-year-old woman presented to the emergency department with 1 week of diffuse pruritic body rash, nausea, and high-grade fever. Her medical history was significant for multiple transient and ill-defined neurologic and gastrointestinal complaints for which she had sought numerous medical opinions without a satisfactory diagnosis. She sought care from a “Lyme-literate doctor,” a term used by certain physicians who prescribe prolonged antibiotic courses to treat chronic Lyme and other tick-borne diseases. Approximately 6 months prior to presentation, that physician diagnosed her with chronic Lyme disease and babesiosis based on results from a Lyme specialty laboratory that used nonvalidated serologic studies. Of note, she reported no preceding rash. Subsequently, she was treated with multiple antibiotic regimens without improvement. During the 3 months prior to admission, she received doxycycline, minocycline, and most recently, trimethoprim-sulfamethoxazole, which she took daily during the 5 weeks before her hospitalization.
Marks CM, Nawn JE, Caplow JA. Antibiotic Treatment for Chronic Lyme Disease—Say No to the DRESS. JAMA Intern Med. 2016;176(12):1745-1746. doi:10.1001/jamainternmed.2016.6229