Cholesterol screening programmes: how much potential benefit?

An early feature of Lyme disease is the distinctive erythema chronicum migrans. Bateman and Lawton described nine patients with Lyme disease who had unilateral or bilateral facial nerve palsies, and in three of these the palsy was associated with this skin lesion.' The induration and erythema seen in my patients may have been those of erythema chronicum migrans. Seven of the patients described here developed swelling and erythema of the face of varying severity that started before the facial nerve palsy. The appearances resembled those of cellulitis, but the affected skin was not painful or tender to touch. In addition, erythema of the tympanic membrane on the affected side was noted in two of these patients. These clinical features have not been reported in Bell's palsy. I recommend that a presumptive diagnosis of Lyme disease should be made in any patient presenting with a facial nerve palsy that is associated with induration and erythema of the face. The diagnosis becomes more probable if the patient presents in the summer and lives in, or has visited, an area in which the vector may be found. Treatment with an antibiotic should be started as soon as Lyme disease is suspected, rather than be delayed until the diagnosis has been confirmed by serological tests, because prompt treatment may hasten recovery from what would otherwise be a disfiguring complaint lasting several months.