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August 1990

Possible Lyme Carditis—Not Definite

Arch Intern Med. 1990;150(8):1755. doi:10.1001/archinte.1990.00040031755031

In Reply.—  Steere has stated that the diagnosis of Lyme disease can be made on clinical grounds.1,2The rash can develop over 3 days, reaching its full size as early as 3 days. It can fade within 1 day as noted by Steere.We feel that the clinical story, geographic location, time of year, and negative clinical and laboratory findings regarding other causes establishes the diagnosis of Lyme disease in this patient on clinical grounds. Indeed, we treated the patient prior to receipt of the antibody titer report.2-3We believe the literature supports our conclusion that a single very high titer of IgG antibody to Borrelia burgdorferi in the clinical setting described confirms the diagnosis of Lyme disease. This conclusion is also in agreement with Steere's comments regarding the diagnostic specificity of a single high titer of IgG antibody. . . . "After the first several