However, unlike Lyme, in shingles these symptoms are usually followed by appearance of rashes composed of multiple small blisters along with a nerves dermatome, and shingles can also be confirmed by quick laboratory tests.Facial palsy caused by Lyme disease (LDFP) is often misdiagnosed as Bells palsy. Although Bells palsy is the most common type of one-sided facial palsy (about 70% of cases), LDFP can account for about 25% of cases of facial palsy in areas where Lyme disease is common. Compared to LDFP, Bells palsy much less frequently affects both sides of the face. Even though LDFP and Bells palsy have similar symptoms and evolve similarly if untreated, corticosteroid treatment is beneficial for Bells Palsy, while being detrimental for LDFP. Recent history of exposure to a likely tick habitat during warmer months, EM rash, viral-like symptoms such as headache and fever, and/or palsy in both sides of the face should be evaluated for the likelihood of LDFP; if it is more than minimal, empiric therapy with antibiotics should be initiated, without corticosteroids, and reevaluated upon completion of laboratory tests for Lyme disease.Unlike viral meningitis, Lyme lymphocytic meningitis tends to not cause fever, last longer, and recur. Lymphocytic meningitis is also characterized by possibly co-occurring with EM rash, facial palsy, or partial vision obstruction and having much lower percentage of polymorphonuclear leukocytes in CSF.Lyme radiculopathy affecting the limbs is often misdiagnosed as a radiculopathy caused by nerve root compression, such as sciatica.
Radiographic features
Whilst some symptoms of DSS can be visually identified, many key symptoms of DSS cannot be identified as such. Therefore, radiographic techniques are required to reach a correct diagnosis for DSS. Abnormal features of the axial skeleton
Skull
In the skull, sclerosis is predominantly observed in the cranial vault and skull base. Other symptoms displayed in the skull include dental anomalies such as abnormal dentition, hypodontia and impaired tooth calcification; intracranial calcifications, which is the calcification of the brain parenchyma; narrow optic canal and other cranial foramina. Abnormal features of the appendicular skeleton
Chest
The ribs are sclerotic, truncated, expanded, and featureless. Sclerosis is also present in the sternum, clavicles and scapulae. Pectus carinatum, a chest deformity, is also characteristic of the disease. Long bones
Sclerosis of epiphyses, diaphyses, and metaphyses with increased radiolucency are key characteristics of the disease. In addition, mottled metaphyseal sclerosis and widening are also present in patients. Development of irregular patchy sclerosis along the bone can also be identified, as well as metaphyseal flaring evolve towards Erlenmeyer flask deformity with nonuniform patches of sclerosis, which are especially prevalent in older patients.The metadiaphyses, a portmanteau of the metaphysis and diaphysis, are bulbous and expanded with bowing and relative radiolucency. The expanded regions are also sclerotic and gives the characteristic bone-in-bone appearance. Spine
Platyspondyly is the development of flattened vertebral bodies, which is one of the most notable symptoms as it distinguishes DSS from other similar diseases such as osteosclerosis. It is observed to be most significant in the thoracic region with increased intervertebral spaces.