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
LaRaia PJ. Possible Lyme Carditis—Not Definite. Arch Intern Med. 1990;150(8):1755. doi:10.1001/archinte.1990.00040031755031