Spotting the target: clinical clues in the diagnosis of disseminated Lyme disease in pregnancy

Published:March 18, 2022 DOI:

A 33-year-old G2P1 woman at 33 weeks’ gestation presented with 10 days of bifrontal headache despite treatment with sertraline, butalbital-acetaminophen-caffeine, and prochlorperazine and 2 days of pruritic body rash (Figure 1).

Blood pressure and urine protein: creatinine ratio were within normal limits, but she had mild transaminitis. Her rash was originally thought to be caused by a drug-induced hypersensitivity reaction, however, in addition to a generalized morbilliform eruption, a physical examination revealed a large annular erythematous patch with a dusky center on the left popliteal fossa (Figure 2)  and similar smaller annular lesions on the buttocks and legs (Figures 3 and 4).

The findings of large and multiple erythema migrans lesions and associated headache prompted a high suspicion for disseminated Lyme disease with neurologic involvement. Serum tests for Lyme disease, including whole-cell enzyme-linked immunosorbent assay and Western blot (for immunoglobulins M and G), were positive. A lumbar puncture revealed elevated red blood cells and nucleated cells in the cerebrospinal fluid consistent with neurologic involvement of Lyme disease. The patient recovered with intravenous ceftriaxone for 2 weeks for disseminated Lyme disease. She delivered a healthy baby boy at 40 weeks’ gestation.

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Unfortunately many do not remain “recovered” after only 2 weeks of antibiotics.  This woman and her baby need to be watched over time.  If mysterious, migrating symptoms continue – they need retreatment.

This is a perfect example of a glaring problem with Lyme/MSIDS.  Mainstream medicine treats it as they do other infections when this is a relapsing illness that is stealthy, embeds itself in the human body, (making it hard for treatments to reach it) is often polymicrobial (numerous pathogens that require different medications), is pleomorphic (changes forms) so the body can’t recognize it as a “bad guy,” and is often relapsing (reappears) at a later date due to stress when the body is in a weakened state.

Please read a few articles to understand these issues better:

For more on Lyme/MSIDS in pregnancy:

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