Possible Lyme meningitis.

Lyme disease was first recognized in 1975 because of a cluster of patients with arthritis in the vicinity of Lyme, Connecticut. Subsequently the arthritis was linked with erythema chronicum migrans (88%), cardiac (8%), and nervous system diseases (11%). By 1983, the etiology of the disease had been confirmed as an infection caused by a spirochete, Borrelia burgdorferi, transmitted to man by the bite of a tick, Ixodes dammini. Then it became apparent that this was the same disease reported as far back as the 1920's, known in Europe as tick-borne meningeal polyneuritis, lymphocytic meningoradiculitis, or Bannwarth's syndrome. The usual presentation includes exposure to ticks or tick-infested areas of the Northeast, the characteristic rash, and then the neurological abnormalities, then the arthritis. This case is presented to illustrate the possible presence of the disease with no history of tick exposure, no travel to areas usually considered endemic and no characteristic rash.