NURS 6501: Final Exam:
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A young adult patient presents in July with a 1-week history of intermittent headaches, dizziness, and multiple erythema migrans lesions. The patient recalls a tick bite after a hiking trip in late May. ECG demonstrates heart block. Serologic testing for Borrelia burgdorferi is positive by ELISA and confirmed by Western blot. What is the likely diagnosis?
Group of answer choices
- Early disseminated Lyme disease
- Early localized Lyme disease
- Early localized ehrlichiosis
- Early disseminated ehrlichiosis
The correct answer is:
Early disseminated Lyme disease
Explanation:
This patient presents with a combination of erythema migrans lesions, headaches, dizziness, and heart block, all of which are classic signs of early disseminated Lyme disease. The timeline and symptoms align with this diagnosis:
Erythema migrans: This is the hallmark skin lesion of Lyme disease caused by Borrelia burgdorferi, usually appearing within a few days to weeks after a tick bite.
Heart block: This is a common feature of early disseminated Lyme disease, particularly in the second or third degree, and occurs as the infection spreads through the bloodstream.
Positive serologic testing (ELISA followed by Western blot confirmation) supports the diagnosis of Lyme disease.
Here's why the other options are less likely:
Early localized Lyme disease: This is typically limited to the presence of erythema migrans without any systemic involvement (like heart block or neurological symptoms). The patient's heart block and other systemic symptoms suggest dissemination of the infection.
Early localized ehrlichiosis: Ehrlichiosis, caused by Ehrlichia species, generally presents with symptoms like fever, headache, muscle aches, and occasionally a rash. It does not typically cause erythema migrans or heart block.
Early disseminated ehrlichiosis: Similar to early localized ehrlichiosis, but ehrlichiosis does not commonly cause the characteristic erythema migrans lesions or heart block.
Thus, the most likely diagnosis for this patient with headaches, dizziness, erythema migrans, and heart block, confirmed by positive serologic testing for Borrelia burgdorferi, is early disseminated Lyme disease.
