Lyme Disease in Canada

A 68-year-old woman presented to the emergency department in Kelowna, British Columbia, with a 3-day history of fever, fatigue, weakness, confusion, headache and diplopia. On initial assessment, she was febrile (38.8°C), and a screening neurologic examination showed a right cranial sixth nerve palsy and mild left-sided pyramidal weakness. The patient had a small erythematous mark on her right shoulder, but no target lesion. She was on vacation from the Ottawa region of Ontario and had been previously well. Her medical history was unremarkable.