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Response to Canadian Medical Association Journal Lyme practice scenario

Re: Decisions; A 35-year-old man with a positive Lyme test result from a private laboratory

Debra L. Fraleigh, Co-founder

Ontario Lyme Alliance

This fictional practice case scenario needs to have some modicum of realism if it is intended to be useful to inform diagnostic and treatment decisions. The patient, who believes he could have Lyme disease and felt compelled to pay out-of-pocket for more potentially informative testing than is available in Canada, would most likely have an extensive list of multi-systemic symptoms, not just one (i.e. fatigue).(1)

He might have shown his primary care provider a rash one year before, but had been told that it looked like a bruise, ringworm, a “spider” bite or cellulitis. Erythema migrans lesions can be highly variable. Unfortunately, many articles (like this one) that continue to promote the misconception that EM rashes are always of “bull’s-eye” form are still being accepted for publication when, in fact, a target shaped lesion is a relatively uncommon presentation (less than 20%). (2, 3)

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