skip to main content

Lyme Disease — SCE Infectious Diseases MCQ

Instant feedback + full explanation. One question, done properly.

ModerateCNS InfectionLyme DiseaseSCE Infectious Diseases

A 30-year-old man presents with a week of progressive facial nerve palsy, meningism, and an expanding erythematous annular rash on his thigh. He was hiking in the New Forest 3 weeks ago. Lyme serology (two-tier testing: EIA then immunoblot) is positive. CSF shows lymphocytic pleocytosis. What is the most appropriate treatment?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — IV Ceftriaxone 2 g daily for 21 days

This patient has Lyme neuroborreliosis (facial nerve palsy with meningitis) confirmed by positive serology and CSF pleocytosis. NICE NG95 recommends IV Ceftriaxone 2 g daily for 21 days for Lyme disease with CNS involvement (meningitis, radiculopathy, encephalitis). Oral Doxycycline 21 days is an acceptable alternative for isolated facial nerve palsy without meningitis in some guidelines (IDSA/AAN), but with CSF pleocytosis, IV therapy is preferred in UK practice.

Reference: NICE NG95 2018 – Lyme disease; UKHSA 2024 – Lyme disease guidance