10 June 2023
: Case report 
Diagnostic Dilemma in a Case of Lyme Borreliosis Presenting as Severe Anion Gap Metabolic Acidosis: A Case Report
Unusual clinical course, Challenging differential diagnosis, Rare coexistence of disease or pathology
Lindsey A. Wallace1ABDEF*, Sarah Cullison1AE, Jacob Bowdon1BCDEF, Aditya Shah2DE, Sumera Ahmad3ADEFDOI: 10.12659/AJCR.939196
Am J Case Rep 2023; 24:e939196
Table 2. Cerebrospinal fluid analysis from lumbar puncture.
| Patient’s result | Reference value/range | |
|---|---|---|
| Color | Clear | Clear |
| Protein | 68 | 0–35 |
| Glucose | 93 mg/dL | (60% of plasma glucose) |
| Total nucleated cells | 2/mcL | 0–5/mcL |
| Erythrocytes | 1/mcL | 0/mcL |
| Neutrophils | 75% | 2±4% |
| Lymphocytes | 22% | 60±20% |
| Monocytes/macrophages | 3% | 30±15% |
| Eosinophils, basophils, other cells | 0% | 0% |
| Blasts | 0 | 0 |
| Encephalitis panel* | Negative | Negative |
| Ehrlichia chaffeensis antibody IgG | Negative | Negative |
| Ehrlichia muris eauclairensis | Negative | Negative |
| Babesia microti, duncani, divergens PCR | Negative | Negative |
| Babesia microti IgG Ab | <1: 64 | <1: 64 |
| Powassan virus IgM ELISA | Negative | Negative |
| HIV 1/2-antigen and antibody screen | Negative | Negative |
| Syphilis IgG with reflex EIA | Negative | Negative |
| RPR screen with reflex to titer | Negative | Negative |
| Urine test for West Nile | Negative | Negative |
| * Encephalitis panel tested for the following: K1, , , , , , cytomegalovirus, enterovirus, herpes simplex 1 & 2, human herpesvirus 6, human parechovirus, varicella zoster virus, and . EIA – enzyme immunoassay; HIV – human immunodeficiency virus; RPR – rapid plasma reagin. | ||