SIR: We appreciate the letter from Drs. Fallon and Nields, who are indeed correct that syphilis and Lyme disease are caused by spirochetes. The sentence to which they refer in the article should have read, "Other viral encephalitides, syphilis, and Lyme disease may present similarly to ADEM…"
We concur with their comments on serologic or CSF titers in Lyme disease. We would recommend using these test results as one piece of data in considering the overall clinical picture and weighing risks and benefits of different treatment options for persistent encephalomyelitis.