Fibromyalgia Syndrome also occurs. More constipation than diarrhea. Often begins as a definitive febrile flu-like illness. Fatigue is prominent. Pushing oneself past the point of early fatigue greatly increases fatigue experienced subsequently, sometimes for days.
Muscle pain predominates.
Fibromyalgia pattern of tender points is common. Irritable bowel syndrome. When risk factors exist for Lyme Disease, and the clinical picture fits, a diagnostic trial of antibiotics is warranted regardless of Lyme serology status. A Herxheimer response to high dose oral antibiotics is suggestive of Lyme disease, and warrants continued aggressive antibiotic therapy. A Herxheimer, or die-off, reaction is a worsening of symptoms that occurs when spirochete antigens are released and cause immune activation.