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severe headaches, eye pain, light sensitivity, dizziness, paresthesias,
muscle twitching, ear pain, pain in head, respiratory problems, mental
fogginess, lightheadedness, dizziness, tingling in different areas
of body, cognitive difficulties. She observed four week cycles of light
sensitivity. [more, added to version 26.3.04 by J. Gruber]
In November , she was treated for the possibility of Lyme Disease with 4 weeks of Ceftriaxone infusions. Three days after starting Ceftriaxone her respiratory symptoms resolved. About 10 days into the treatment she had a diffuse rash, as well as fever, chills, swollen glands, and multiple swollen joints. She continued the treatment and those symptoms resolved.
After one month she had very marked resolution of symptoms , very clear-cut, as was the resolution of the optic neuritis to Clyndamycin. Also, it is noteworthy that she had persistent respiratory problems which also resolved very promptly with institution of Ceftriaxone.(graphical display of diary of symptoms)
Marianne suffers from chronic neuroborreliosis based on her clinical history, MRI findings -and favourable changes on repeat MRI following intensive antibiotic therapy-, CSF findings, Lyme Western blots (34 and 39 KiloDalton bands) and clinical response to antibiotics.
In my opinion, the diagnosis of Lyme disease is quite clear on clinical
grounds regardless of what serologic tests show. It is my opinion, in my
experience, seronegativity is not rare and that immune response can be
very desultory and may take months or even years to become apparent.
Since the patient is not asymptomatic and since there is at this point abundant evidence in the worldwide medical literature that treatment for Lyme Disease may be suppressive and not curative, I feel that it is appropriate to offer the patient further antibiotic therapy. She was given a prescription for Ceftin for a dosage range between 500 mg up to 2.000 mg po q12h depending on impact and tolerance. We may opt to change therapy depending upon response. Also, it was discussed that it may prove necessary for the patient to have further parenteral antibiotic therapy. At the time in January  it was not clear whether that would be necessary.
More recently, Lyme urine antigen test was performed which was positive for detection of shed proteins specific for Lyme Disease.
Since she does report cyclic symptomatology [for a statistical analysis of the symptomlog see Figs. 2, 3, 4, 5] suggestive of persistent active borreliosis [background], continued intensive treatment is warranted [a tentative rationale for the determination of end of treatment]. Considering the serious neurologic involvement she has manifested, treatment of maximal intensity is appropriate.