Leonard H. Sigal, MD, FACP, FACR
Division of Rheumatology
UMDNJ - Robert Wood Johnson
Medical School
New Brunswick, NJ

History of Chronic Lyme Disease vs True Lyme Disease

Objective historical features of prior Lyme disease are often lacking in chronic Lyme disease, although plausible tick exposure or having been present in an endemic area is often cited. In too many cases, however, the latter two are the only “evidence” for Lyme disease. Although a “summer flu” may be recalled, it is important to remember that true gastrointestinal and upper respiratory complaints are very infrequent in true Lyme disease. Later in the evolution of chronic Lyme disease, rashes may be recalled that had not been noted by the original physicians or rashes that were noted become altered with time to resemble a bull’s eye lesion while only about 1/3 of all erythema migrans rashes have the bull’s eye appearance (10). A review of the literature on Lyme disease reveals there are no unique symptoms (1,9,10,14) that are pathognomonic. Such a vague and nonspecific history cannot be taken as serious evidence of prior Lyme disease. By the time a consultant sees them, these patients have been treated. There may be symptomatic improvement, often transient or imcomplete, after antibiotics. If the symptoms return after cessation of therapy, rather than suggesting that more antibiotics are needed, the diagnosis should be reconsidered.

Once chronic Lyme disease is entered into the record, it can become a permanently erroneous focus for subsequent attribution (1). Having noted chronic Lyme disease as the reason for referral, some consultants include “compatible with Lyme disease” in their report, even if there is no evidence suggesting Lyme disease, accepting the referring doctor’s conclusions and attributing current symptoms to a long-gone (if ever present) infection, which simply solidifies the hold of chronic Lyme disease.

The diagnosis of Lyme disease must be made carefully, based on findings that objectively suggest that diagnosis. It is incumbent upon a consultant to confirm the propriety of the initial diagnosis of Lyme disease. The diagnosis of chronic Lyme disease often does not survive close scrutiny.