This case presentation discusses a 36 year-old female animal care worker presenting with an acute-onset polyarthropathy during the summer months in a Lyme endemic region. Though she appeared to be a good candidate for the diagnosis of Lyme borreliosis, her screening serology reported negative results and alternative diagnoses were considered. Her subsequent diagnosis with parvovirus B19 acts to remind the general practitioner to have confidence in the accuracy of a negative Lyme screen and, upon negative result, to expand the differential to include less common infections including parvovirus B19. It also highlights the need to remember parvovirus B19 in a similar patient who has the potential to be or to become pregnant during the course of her illness.
Conflict(s) of Interest
References with DOI
1. Nelson CA, Saha S, Kugeler KJ, Delorey MJ, Shankar MB, Hinckley AP, et al. Incidence of cliniciandiagnosed Lyme disease, United States, 2005–2010. Emerg Infect Dis. 2015 Aug. https://doi.org/10.3201/eid2109.150417
2. Lyme disease (Borrelia burgdorferi) 2011 Case Definition [Internet]. National Notifiable Disease Surveillance System. Centers for Disease Control and Prevention; Available from: https://wwwn.cdc.gov/nndss/conditions/lyme-disease/case-definition/1996/
3. Johnson BJB. Laboratory Diagnostic Testing for Borrelia burgdorferi Infection. In: Lyme Disease: An Evidence-based Approach. CAB International; 2011. p. 73–88. https://doi.org/10.1079/9781845938048.0073
4. Lamont R, Sobel J, Vaisbuch E, Kusanovic J, Mazaki-Tovi S, Kim S, et al. Parvovirus B19 infection in human pregnancy. BJOG: An International Journal of Obstetrics & Gynaecology. 2010;118(2):175–86. https://doi.org/10.1111/j.1471-0528.2010.02749.x
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Moffett, Natalie A. and Lorenzetti, Rosemarie
"When It Isn’t Always Lyme: Expanding the Differential Diagnosis for Acute-Onset Polyarthralgia in the West Virginia Eastern Panhandle,"
Marshall Journal of Medicine:
4, Article 9.
Available at: https://mds.marshall.edu/mjm/vol2/iss4/9