A fluid circumstance: Lyme spinal arthritis

A previously unreported sign and related symptoms overshadowed the revelatory clue in a patient with early infection. A 25-year-old man from New England awoke with posterior neck pain that progressively worsened over the next three days. He sought treatment at a general medicine clinic where he had an unremarkable physical examination and reported no significant medical history. Results from a complete blood count with differential, a complete metabolic panel, and a cervical spine x-ray were normal. He was sent home with prescriptions for ibuprofen and cyclobenzaprine. The next day, he presented to the emergency department in our hospital with a fever of 104.4°F (40.2°C), chills, and photosensitivity. Here, Mizusawa and Duncan discuss the assessment and management of acute lyme spinal arthritis.