We describe the clinical courses of 5 patients with Lyme disease who developed significant late complications, despite receiving tetracycline early in the course of their illness. All 5 patients had been treated for erythema chronicum migrans with a course of tetracycline that met or exceeded current recommendations. The late manifestations of Lyme disease included arthritis, cranial nerve palsy, peripheral neuropathy, chronic fatigue, and changes in mental function. Our findings suggest that the use of tetracycline at a dosage of 250 mg, 4 times a day for 10 days, as a treatment for early Lyme disease should be reconsidered. To determ9e optimal therapy for early Lyme disease, a study that compares an increased dosage of tetracycline with alternative treatments is indicated.
Lyme disease was recognized as a distinct clinical entity in 1976, when a cluster of cases occurred in a small area in the vicinity of Old Lyme, Connecticut (1). An illness characterized by a similar complex of symptoms, erythema chronicum migrans (ECM; the skin lesion of Lyme disease), neurologic symptoms, and a history of tick bite (2-5), was originally described in Europe in the first half of the twentieth century. In the early 1980s, the spirochete Borreliu