Christina's World and the Universe of Lyme Disease

Abstract

Radonjic's article about Andrew Wyeth's masterpiece, Christina's World,1Radonjic A The undiagnosed patient in Christina's World.Am J Med. 2020; 133: 253-254Abstract Full Text Full Text PDF Scopus (2) Google Scholar is thought-provoking even though it simply covers old ground about the possible diagnosis of Charcot-Marie-Tooth (CMT) polyneuropathy in the woman who is the subject of the painting.2Patterson MC Cole TB Siegel E Mackowiak PA A patient as art: Andrew Wyeth's portrayal of Christina Olson's neurologic disorder in Christina's World.J Child Neurol. 2017; 32: 647-649Crossref Scopus (4) Google Scholar As is often the case in art and medicine, however, viewing a picture with fresh eyes may reveal new possibilities. Therefore, it is worthwhile to consider a different diagnosis in this young woman of Scandinavian descent lying in a lush New England field of grass. A striking feature of the painting is the severe joint disease and deformity in Christina's arms and hands. Charcot-Marie-Tooth polyneuropathy primarily affects the lower limbs (“stork legs”), so another chronic disease that causes neuropathy, arthritis, and muscle wasting in the upper extremities merits consideration. This leads us to a diagnosis of Lyme disease. Tick-borne disease was known in Scandinavia since at least 1909, when Arvid Afzelius presented his seminal observation of a fleeting rash and neurological symptoms associated with a tick bite.3Hellerstrom S Erythema chronicum migrans Afzelius with meningitis.South Med J. 1950; 43: 330-335Crossref Scopus (18) Google Scholar Although it would take some time to be recognized in the United States, imported or domestic cases of Lyme disease were probably present in North America long before they were recognized by that name.4Flanagan BP Erythema chronicum migrans Afzelius in Americans.Arch Dermatol. 1962; 86: 410-411Crossref Scopus (10) Google Scholar Could Christina have suffered from congenital Lyme disease or tick-borne infection acquired as a young girl while lounging in that lush grass? Of course we will never know. Unfortunately, the response that Christina received from the doctors at Boston City Hospital was similar to what patients with chronic Lyme disease hear from many doctors today: “Sorry, we cannot help you.” Although the diagnosis of chronic Lyme disease remains controversial, recognition of this debilitating illness is now possible using an evidence-based case definition, and effective treatment of the disease is within our reach.5Stricker RB Fesler MC Chronic Lyme disease: a working case definition.Am J Infect Dis. 2018; 14: 1-44Crossref Google Scholar,6Stricker RB Johnson L Lyme disease: the promise of Big Data, companion diagnostics and precision medicine.Infect Drug Resist. 2016; 9: 215-219Crossref Scopus (9) Google Scholar The disease that may have caused so much pain and suffering in Christina's World should no longer do so in ours.