Clinical Practice and Cases in Emergency Medicine

Introduction: Lyme disease is most prevalent in the Northeast and Midwest regions of the United States, as well as northern California; however, cases have been reported in nonendemic areas, including the Southwestern United States. Atypical presentations or underreporting can cause delay in diagnosis. 

Case Report: We present the case of a 22-year-old previously healthy man, who presented to our emergency department in metropolitan Phoenix with five days of headache, fever, meningismus, and photophobia, and later developed focal neurologic deficits consistent with Lyme meningitis. Cerebrospinal fluid was notable for lymphocytic pleocytosis, and Western blot for Borrelia burgdorferi Immunoglobulin-M antibodies was positive, which led us to Lyme meningitis as the unifying diagnosis. He was treated with intravenous ceftriaxone and his symptoms resolved. 

Conclusion: This case highlights the importance of considering this pathology in nonendemic areas.