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Postoperatively, she had developed leg pain (treated with corticosteroids) and a diffuse rash. Examination showed multiple cranial nerve palsies and confluent macules on her buttocks and leg. MRI confirmed unilateral enhancement of cranial nerves III, V, VI, and VII (see ). Although a surgical site infection was considered, it did not explain all her symptoms. Testing for Lyme disease was pursued, and borreliosis was confirmed.
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Comment
It’s reasonable to blame recent surgical procedures for a patient’s new symptoms. But anchoring on this “Chekhov’s gun“ is not; not every element of a story must play a role in the plot. Sure, the stress of surgery may have been a factor, but the more salient clues were the patient’s residence in easter…