A patient comes with the chief complaint of drooling of saliva on the right side of face and inability to close his right eye. This happened 2 days ago. He describes a reddish rash close to his left ankle about a week ago. He generally feels well and has no other complaints. his appetite is good and his weight has been stable. He was out camping about 2-3 weeks ago and does not remember any bites or cuts.
Which one of the following tests is useful in the initial workup of this patient?
This is typical of Lymes disease. The initial test is
ELISA. Confirmatory test is Western Blot. The best choice is choice 3.
Other diseases that one must think of with a mononeuropathy
are: Diabetes mellitus, Sarcoidosis, Carcinomatous neuropathy, Wegeners/PAN/other
vasculitis.
EKG in lymes disease can show prolonged PR interval, I do not know of any culture done for lymes disease.
The tests for the differential are
Diabetes mellitus: Blood sugar
Sarcoidosis: CXR (remember that they are anergic)
Carcinomatous neuropathy: Routine cancer screening appropriate to age or symptoms if any
Wegeners/PAN/other vasculitis: cANCA (proteinase 3), pANCA (Myeloperoxidase), ANA
respectively.