CANADA, CASE REPORT: New-onset Bell palsy and Lyme disease

[Canlyme Note: It is important for physicians to be aware that treatment duration is to be determined by the clinical presentation not by preset limitations. The only recognized guidelines that meet the Institute of Medicine GRADE level criteria, which are the only Lyme disease guidelines published on the US government guideline website, are those published by the International Lyme and Associated Diseases Society (ILADS).  See ILADS guidelines here.]

Scenario

You are seeing a healthy-looking 46-year-old man for follow-up. He had presented to the emergency department with sudden onset of left-sided facial drooping. He had no relevant past medical history. The only relevant finding on physical examination apart from left facial drooping was an inability to completely close the left eyelid and several red blotchy areas with dusky centres on his back approximately 2 cm in height and 3 to 5 cm in length. Routine bloodwork results were normal. On closer questioning the patient reported frequent hiking in New England, Quebec, and Ontario over the summer. His diagnosis was probable early disseminated Lyme disease presenting as Bell palsy with multiple erythema migrans lesions. Serology for Lyme disease was ordered, and he was prescribed 100 mg of oral doxycycline twice a day for 10 days until he saw you for follow-up…

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