Infectious Disease Q 9

A 44-year-old woman is evaluated for persistent fatigue, headache, myalgia, and arthralgia. Early localized Lyme disease was diagnosed 2 months ago after the patient returned from a camping trip in western New Jersey with the symptoms described and a skin eruption of erythema migrans. She was treated with a 14-day course of doxycycline with resolution of the cutaneous lesions but continuation of the other symptoms, which now are adversely affecting her work and personal life. Her only medication is ibuprofen.

On physical examination, vital signs are normal. The patient has full range of motion of the joints. No skin lesions, synovitis, or effusions are noted.

Results of laboratory studies, including a complete blood count, comprehensive metabolic panel, and lactate dehydrogenase measurement, are all within normal limits.

Which of the following is the most likely diagnosis?

A Anaplasmosis

B Babesiosis

C Late-stage Lyme disease

D Post–Lyme disease syndrome

E Powassan virus infection

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