Lyme Disease First Observed to Be Aseptic Meningitis

Lyme disease is a recently described inflammatory disorder characterized by the appearance of a unique skin lesion, erythema chronicum migrans, recurrent attacks of arthritis, and occasional involvement of the heart and nervous system.¹ Although the etiologic agent has not been determined, epidemiologic observations suggest that this disease is transmitted by a tick bite, primarily Ixodes dammini.² The purpose of this report is to point out that in children, Lyme disease may first be observed to be an illness indistinguishable from aseptic meningitis unless the history or physical examination provides evidence of the characteristic skin lesion. The importance of correctly diagnosing Lyme disease rests in the need for continued observation for possible late sequelae.

Report of a Case.—A 13-year-old boy had temperatures to 38.3 °C and headaches when he returned from summer camp on Cape Cod. During the second week after his return from camp, the headaches became