PDF(Pubmed)
Abstract：
Lyme disease progresses through three distinct clinical phases: early localized, early disseminated, and late disseminated. Lyme arthritis is characterized by attacks of joint swelling lasting for weeks to months, potentially causing permanent joint damage in late disseminated disease. Our case focuses on a 63-year-old, obese, type 2 diabetic, wheelchair-bound, Caucasian male with severe bilateral knee pain. Our patient had previously undergone bilateral knee arthroscopies for meniscal tears and also had knee injections performed previously without the desired level of pain alleviation. He indicated a recent cough that was treated with erythromycin and noted his knees felt better during the course of the antibiotic. The patient recreationally enjoyed hunting and mentioned that his dog had Lyme Disease. Laboratory confirmation of Lyme disease prompted our patient to be treated with doxycycline. Upon completion of doxycycline therapy, our patient noted significant improvement in his knee pain. The improvement was significant enough that the patient canceled a planned bilateral knee replacement with his orthopedic surgeon, and no longer required the use of a wheelchair as he was able to return to ambulating independently. The patient\'s quality of life improved significantly, and he could also return to work. Lyme disease should be a consideration in the differential diagnosis of patients in areas endemic to the disease, and patients who tend to have outdoor lifestyles.
摘要：
莱姆病通过三个不同的临床阶段进展：早期局部，早期传播，后期传播。莱姆关节炎的特点是持续数周至数月的关节肿胀发作，在晚期传播疾病中可能导致永久性关节损伤。我们的案子集中在一个63岁的老人身上,肥胖，2型糖尿病,轮椅,白种人男性伴严重双侧膝关节疼痛。我们的患者先前曾因半月板撕裂而接受过双侧膝关节镜检查，并且先前也进行了膝关节注射，但没有达到预期的疼痛缓解水平。他指出最近用红霉素治疗的咳嗽，并指出他的膝盖在抗生素治疗过程中感觉更好。患者娱乐性地喜欢狩猎，并提到他的狗患有莱姆病。莱姆病的实验室确认促使我们的患者接受多西环素治疗。多西环素治疗完成后，我们的患者注意到他的膝关节疼痛有了显著的改善.这种改善非常显著，以至于患者取消了计划中的矫形外科医师进行的双侧膝关节置换手术，并且不再需要使用轮椅，因为他能够独立返回步行。患者的生活质量明显提高,他也可以回去工作.莱姆病在疾病流行地区的患者的鉴别诊断中应考虑，和倾向于户外生活方式的患者。
