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Show Journal of Clinical Neura-ophthalmology 8(4): 253, 1988. Editorial Comment Lyme disease is now said to be the first suspected cause of a unilateral or bilateral Bell's palsy in Europe. There is an increasing appreciation of the crossover of seroreactivity between syphilis and Lyme disease. We now recommend that a serum VORL test with titer, a serum FTA-ABS test, and both immunofluorescent antibody IgG and IgM as well as ELISA tests be obtained for any patient with a suspicion of Lyme disease in the differential diagnosis. The patient reported by Dr. Keane undoubtedly had secondary syphilis because of the clinical presentation of the generalized rash with palmar in- 253 © 1988 Raven Press, Ltd., New York volvement. Follow-up titers will be helpful in that patient. One would also find it interesting to send the unstained slides of the lip biopsy in this patient off for very careful silver stains to see if any spirochetes could be seen in that tissue showing the chronic inflammation. Dr. Alan MacDonald would probably be quite interested in viewing silver stains of that tissue. This case also documents aberrant regeneration of the facial nerves following syphilitic seventh nerve palsies. Thank you, Dr. Keane, for presenting this interesting patient. J. Lawton Smith, M.D. |