Sharma, Umesh

An elderly woman with a history of hypertension, hypothyroidism, mesenteric vein thrombosis, depression and hyperlipidaemia on statins for >9 years presented with new-onset leg weakness, falls, dark-coloured urine, transaminitis and rhabdomyolysis (creatinine phosphokinase 12 896 U/L; aldolase 45.9 (normal <7.7 U/L). Workup for autoimmune myositis was negative. The patient had clinical and laboratory improvement with discontinuation of statins with the return of clinical strength and creatinine phosphokinase back to baseline levels (51 U/L) within 2 weeks.

A 45-year-old man was presented with 3 weeks of fever, chills, headache, myalgia and sweats after returning from a camping trip. He had multiple erythematous, blanching, non-target lesions on back and lower abdomen and oral pseudomembrane. He was empirically started on doxycycline for presumed Lyme disease and hydration for management of acute renal failure. Next day, he was started on vancomycin for worsening rash and coverage of methicillin-resistant Staphylococcus aureus skin infection and fluconazole for possible thrush and tested for HIV, syphilis, tick-borne diseases, arboviral panel, Epstein-Barr virus, rapid plasma reagin and rheumatoid factor. Initial Lyme’s screening test was negative. Over the next 4 days, rash and headache improved significantly and Epstein-Barr DNA and immunoglobulin M Lyme antibody came back positive. After discussion with Infectious Diseases colleagues, doxycycline was continued for 3 weeks for management of early disseminated Lyme disease. Patient had no recurrence of his symptoms at 4 week follow-up visit.