A case of Lyme disease in a Japanese woman

Abstract

This report presents the case of a Japanese patient who developed Lyme disease. The patient was a 44-year-old woman who had general fatigue and the inability to open her mouth. She was initially suspected of having mild tetanus with lockjaw; however, she reported a past history of a tick bite while camping in the USA and had erythema migrans 2 months before this visit. Finally, Lyme disease was serologically confirmed. A few cases of Lyme disease are annually reported in Japan; however, this infectious disease should also be suspected.

Keywords: Borrelia burgdorferi; Clostridium tetani; erythema migrans; facial nerve palsy; tetracycline.

Figure 1

Skin erythema migrans seen in the present patient (The photo was kindly provided by the patient).

Figure 2

Anti-Borrelia antibodies detected by recomLine Borrelia IgG and IgM strip immunoassays (Mikrogen Diagnostik, Neuried, Germany). Sera 2055 and 2056 were collected in July and August 2017, respectively. The patient’s sera reacted to various recombinant antigens as follows; p100 (93 kDa antigen), VlsE, p41 (41 kDa antigen, Flagellin), p39 (BmpA), OspCs (21–24 kDa antigen), and p18 (18 kDa antigen). The test result suggested the patient was serologically IgM and IgG positive for Lyme disease (https://www.mikrogen.de/uploads/tx_oemikrogentables/dokumente/GARLBB007EN.pdf). The patient also tested IgM positive for Lyme disease by the Center for Disease Control and Prevention recommendations. Note: Recommended reading: Test Performance and Interpretation from the Second National Conference on Serologic Diagnosis of Lyme Disease. MMWR. 1995;44(31):590–591. Abbreviations: IgG, immunoglobulin G; IgM, immunoglobulin M.