Lyme Disease with Erythema Migrans and Seventh Nerve Palsy in an African-American Man

《 Our patient’s initial illness displayed several common features of Lyme disease, yet he did not receive testing or treatment for Lyme disease until his third medical visit, 27 days after the start of symptoms, nor was he evaluated for LNB despite the increasing severity of his neurologic symptoms. It is unknown whether this specific case is a direct result of implicit bias; however, it does highlight both the ongoing relevance of early misdiagnosis of Lyme disease and, more broadly, how medical care is shaped by demographic factors such as race, class, and gender [18]. It is well established that implicit bias is widespread in healthcare, but few studies have investigated Lyme disease-related health disparities in the United States, where reports of Lyme disease in patients of color are disproportionately less common than in White patients [19].

Fix et al. have described differences in case reporting between White and African-American patients in a rural endemic area of Maryland with a substantial African-American population [8]. Notably, incidence of EM was lower among African-American patients, whereas incidence of late-Lyme arthritis associated with ongoing infection was higher than in White patients [8]. Together, this suggests that in Lyme disease-endemic areas, African-American patients may be at higher risk for missed or late diagnosis, challenging the common explanation for variation in incidence rates based solely on area of residence [7,8]. This finding, consistent with our patient’s late diagnosis, should prompt investigation of why such delays or misdiagnoses occur.
Demographic factors can influence many aspects of health care access, delivery, and management, including trust between patients and providers; patient education about disease prevention, symptoms, and when to seek care; insurance status; income, including cost and impact; and the potential roles of poverty, discrimination, and stigma [7-9,14,20]. Given shifting populations in the United States, and the increased risk of long-term complications from Lyme disease after delayed diagnosis, there is great need for further study to understand how these types of factors may present obstacles to early diagnosis and treatment of Lyme disease [6,14].》
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An African-American man in his 30s presented following seven weeks of symptoms including an initial febrile illness with a rash followed by onset of fatigue, facial weakness, daily headaches, neck pain, leg numbness, hyperacusis, and photosensitivity. Over the seven weeks, he had several evaluations...

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Lyme Disease with Erythema Migrans and Seventh Nerve Palsy in an African-American Man

An African-American man in his 30s presented following seven weeks of symptoms including an initial febrile illness with a rash followed by onset of fatigue, facial weakness, daily headaches, neck pain, leg numbness, hyperacusis, and photosensitivity. Over the seven weeks, he had several evaluations...