Help!!!

[Racheshonty]

A 40-year-old returned from a deer-hunting trip about 6 weeks ago, and presents to clinic with multiple complaints.  He states that recently he as had worsening joint pain and “arthritis” in multiple joints that seems to move to different spots.  Patient also complains of some numbness in his feet bilaterally.  The patient denies any medical problems and he had a normal annual physical prior to hunting trip.  On further questioning, he remembered having a rash on his body and the lesions were circular and appeared to be resolving in the center.  He noted that he felt really bad once he got home with muscle aches (myalgias), joint aches (arthralgias), stiff neck, and severe headache.  He also remembered that many of his hunting friends had experienced flea and tick bites and is quite sure he was bitten as well.  The physical exam is essentially normal except some joint tenderness of left knee and right shoulder.  After making your diagnosis you gave him a prescription for erythromycin.


QUESTIONS
1-What is the most likely diagnosis?
2-What is the biochemical mechanism of action of erythromycin?

[j_sister]

Check his body from head to toe and everything in between -could be on his scalp- to see if you can find where he was bitten (if he was bitten).  I remember learning about Lyme disease a few years back those were common symptoms.  If another episode of severe HA and stiff neck occur, he should strongly consider going to the ER (severe as in worst HA he has ever experienced)  This is more than likely off base, but I met a man that went camping with friends and at the end of the trip began with these symptoms.  A couple nights later he had the worst HA of his life and when he went to the ER he was Dx with Meningitis.  Like I said probaby way off base, but when I hear Severe HA and stiff neck, I cannot help but think of him.

[mandy876]

could be lime desease from a tick. there are several diseases you can get from insects,  also poison ivy or poison oak. mandy876

[Red_Star]

Likely diagnosis is Lyme Disease. Antibiotics commonly used for Lyme include doxycycline, amoxicillin, or cefuroxime axetil.