LYME DISEASE

CHARLES J. ODGERS, IV, MD, Resident, Orthopaedic Surgery

WILLIAM MACKENZIE, MD, Attending Orthopaedic Surgeon

June 12, 1996

CLINICAL CASE PRESENTATION

ORTHOPAEDIC DEPARTMENT

THE ALFRED I. DUPONT INSTITUTE

WILMINGTON, DELAWARE

CASE HISTORY:

An 8-year-old boy presented with a seven month history of intermittent right elbow pain and swelling. He stated that his discomfort first began when his right arm was twisted by a girl who "got the best of him". This injury was associated with pain, swelling, and loss of ROM of his right elbow. It was initially treated with ice packs with much improvement over the next several days. He had three subsequent episodes of pain and swelling in his right elbow not precipitated by trauma with near-complete resolution of pain between each occurrence. The last episode, occurring three days ago, did not respond to ice packs and significantly limited his elbow ROM. The patient denied history of fevers, chills, or rashes.

PHYSICAL EXAM:

On physical exam, he had a marked effusion of his right elbow, and he was holding his elbow flexed at 90 degrees. His ROM was 50-95 degrees, and was unable to pronate or supinate his forearm. He had no local adenopathy, and the rest of his exam was unremarkable. He did not have any other joint swelling.

DIAGNOSTIC STUDIES

Plain radiographs of his right elbow revealed a posterior fat pad sign consistent with a joint effusion. There was no bony abnormalities on x-ray. An aspiration of his right elbow was performed, the joint fluid being straw colored. It was sent for cell count and lyme titers. Lyme ELISA (on the joint fluid) result was 1:640, and the confirmatory Western blot was positive. The patient was referred to a rheumatologist who placed the patient on doxycycline 100mg BID for 30 days and obtained an EKG to rule out cardiac abnormalities.

LYME DISEASE- ORTHOPAEDIC MANIFESTATIONS
INTRODUCTION
CLINICAL PRESENTATION
EARLY LOCALIZED INFECTION: STAGE 1
EARLY DISSEMINATED INFECTION: STAGE 2
LATE (PERSISTENT) INFECTION: STAGE 3- LYME ARTHRITIS
CLINICAL DIAGNOSIS- SEROLOGIC TESTING
TREATMENT:
REFERENCES:
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  4. Lawrence SJ: Lyme disease: An orthopaedic perspective. Orthop 1993; 15(11): 1331-5.
  5. Rose CD, Fawcett PT, Epps SC, Klein JD, Gibney K, Doughty RA: Pediatric lyme arthritis: clinical spectrum and outcome. J Pediatr Orthop 1994;14(2):238-241.
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