Lyme arthritis (LA) may be confused with other rheumatic diseases, particularly in the absence of a history of erythema migrans (EM). We report the case of a 12-year-old patient who developed a large effusion of the tight knee joint. The titer for antinuclear antibodies was 1:80 and the test for rheumatoid factor was negative. – Investigations for antibody response to Borrelia burgdorferi demonstrated remarkable elevation of IgG antibody and no specific IgM response. These results were confirmed by immunoblotting reactivity with the bands p83/100, p58, p43, p41, p39, OspA, p30, OspC, p21, and p17. We subsequently learned that the child had suffered a tick bite followed by an EM 5 years earlier and had been treated with trimethoprim/sulfamethoxazole at that time. The patient now was given intravenous ceftriaxone, 2 g daily for 14 days. In the absence of clinical improvement 3 weeks later a knee joint aspiration was performed which resulted in a positive polymerase chain reaction (PCR) test for B. burgdorferi DNA (OspA) in the synovial fluid. The patient fully recovered 2 months later without further treatment. The case indicates that the latency period between EM and onset of LA may last up to 5 years. In addition to serologic test methods, analysis of synovial fluid using PCR may be decisive for making the final diagnosis of LA.
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Received: April 19, 1999 · Revision accepted: July 5, 1999
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Albert, S., Schulze, J., Riegel, H. et al. Lyme Arthritis in a 12-Year-Old Patient after a Latency Period of 5 Years. Infection 27, 286–288 (1999). https://doi.org/10.1007/s150100050033
- Polymerase Chain Reaction
- Synovial Fluid
- Latency Period
- Rheumatic Disease