Differential Case Study: Lyme Disease or Covid-19?

Lakeith, a 35-year-old black man living in New York State, presents with a fever of 101 degrees F. He is concerned he might have contracted Covid-19. Based upon a true story, this case study highlights the need to be aware of life-threatening diseases that can masquerade as Covid-19. Specialties Critical Case Study

Updated: Feb 23, 2023

This article was reviewed and fact-checked by our Editorial Team.

Differential Case Study: Lyme Disease or Covid-19?

Chief Complaint

Fever of 101^o F, fatigue and lethargy, stiff neck and jaw, chills and sweating with fever, muscle aches and pains with fever. "I feel like I have the flu. I'm worried I might have Covid-19.”

History of Present Illness

Lakeith awoke on Saturday morning feeling exhausted. As the morning progressed, he began to have aches and pains. He took an oral temperature that was 101^oF. His first thought was that he had contracted Covid-19. He is a home health physical therapist who specializes in geriatric physical therapy. He sees four to five patients each day. Several of his patients have tested positive for Covid-19. When working with any of his patients, Lakeith wears an N-95 mask and gloves and practices strict hand hygiene.

Before calling his primary care provider, Lakeith went online and took the Mayo Clinic Covid-19 Self-Assessment Tool to see if his symptoms fit with those for Covid-19.

Here are the questions with his response

Have you been within 6 feet of a person with a lab-confirmed case of COVID-19 for at least 5 minutes, or had direct contact with their mucus or saliva, in the past 14 days? YES
Does the person with COVID-19 live with you? NO
In the last 48 hours, have you had any of the following NEW symptoms? Check all that apply.

Response	Symptom
Yes	Fever of 100 F (37.8 C) or above
Yes	Fever symptoms like alternating chills and sweating
No	Cough
No	Trouble breathing, shortness of breath or severe wheezing
Yes	Chills or repeated shaking with chills
Yes	Muscle aches
No	Sore throat
No	Loss of smell or taste, or a change in taste
No	Nausea, vomiting or diarrhea
Yes	Headache
No	None of the above

Do you have any of the following possible emergency symptoms? Check all that apply.

Response	Emergency Symptom
No	Struggling to breathe or fighting for breath even while inactive or when resting
No	Feeling about to collapse every time you stand or sit up (floppiness or a lack of response in a child under age 2)
No	None of the above

Is the person with a fever younger than 3 months old? NO
Have you traveled in the past 14 days to regions affected by COVID-19? NO
Do you live in a care facility? NO
Do you work in healthcare? YES

After taking the test, he called his primary care office and the triage nurse directed him to come in for a Covid-19 test.

General appearance

The patient arrived at clinic for a Covid-19 test wearing a mask, shoulders drooping, eyes heavy-lidded. Speech is slow and measured. While the nurse prepped for the test, she noticed the patient repeatedly attempting to scratch his back.

Past Medical History

Uncomplicated appendicitis at age 12

Family History

Father, age 56, and mother, age 52 both have HTN and hypercholesterolemia. Thirty-three-year-old sister with obesity and type 2 diabetes.

Social History

Occasional marijuana use, drinks alcohol 1-2 times weekly. Non-smoker. Lives alone. Patient has a girlfriend of three years. He has been socially isolating since March 15th due to his high-risk job.

Medications

Takes Tylenol or ibuprofen for aches and pains. Daily Allegra for seasonal allergies.

Allergies

NKA

This case study is different from others in that I am letting you know from the start that Lakeith has Lyme disease, Covid-19 or both.

What information do you need to determine his diagnosis? He's had a nasal swab for Covid-19, but the results won't be available for another three days.

What else would you check before he leaves the primary care clinic?

References

Merck Manual Professional Edition: Lyme Disease

DISCLAIMER: These case studies are presented for learning purposes only and with full understanding that it is outside the scope of practice for a nurse to make a medical diagnosis. When participating, assume that a licensed healthcare provider is making the actual diagnosis, ordering all the tests and interpreting the results. You are looking at the case retrospectively to learn from the data presented – the idea is to increase your knowledge so you can sharpen your assessment and teaching skills.

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About SafetyNurse1968, ADN, BSN, MSN, PhD

Patient Safety Columnist / Educator

Dr. Kristi Miller, aka Safety Nurse is an Assistant Professor of nursing at USC-Upstate and a Certified Professional in Patient Safety. She is obsessed with patient safety. Please read her blog, Safety Rules! on allnurses.com.

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