A 26-year-old woman went camping in Connecticut 1 week ago. During her trip she was exposed to mosquito bites and at least on 1 occasion removed an adult tick from the back of her neck. The patient also swam in a small pond but promptly left the area after she identified animal feces in the water. The patient had sexual intercourse with new boyfriend of 6 weeks and smoked marijuana.
She presents now with fever, headache, photophobia, and blurry vision. She has developed a rash affecting her palms and soles (see figure).
Her temperature is 102°F, pulse is 106/minute, and blood pressure is 143/92 mm Hg. Computed tomography of the brain is unremarkable. A lumbar puncture reveals 832 white blood cells with 62% of mononuclear cells. Cerebrospinal fluid (CSF) glucose is normal, and CSF protein is 55 mg/dL. A Gram stain is negative.
This patient likely has which of the following?
This question appears in Med-Challenger Physician Assistant Exam Review with CME
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