Abstract
Background
Lyme disease, spread by the Ixodes tick, is typically associated with a single “bull's eye rash” that emergency physicians
are comfortable recognizing and treating during the summer months when this disease
is most prevalent. However, Lyme disease can also present in disseminated forms that
are more difficult to diagnose.
Case Report
We describe a phenomenon of disseminated Lyme with multiple rash complexes that is
unrecognized by clinicians. A 65-year-old woman with no prior medical history presented
with flu-like symptoms including headache, nausea, and arthralgias, as well as a nonpruritic
rash on her lower limbs. On physical examination, multiple red, blanching patches
with a diameter of up to 20 cm were seen. Although she was initially thought to have
a nonsteroidal anti-inflammatory drug reaction as her skin biopsy for Borrelia burgdorferi was negative, an immunoglobulin M test for B. burgdorferi was found to be positive during her emergency department visit. Despite the diverging
results, a diagnosis of early-disseminated Lyme was made. She was discharged home
on a 3-week course of oral doxycycline, and a complete resolution of her symptoms
was noted on a follow-up visit.
Why Should an Emergency Physician Be Aware of This?
With the incidence of Lyme disease and its atypical presentations on the rise, the
emergency physician should be aware of the other rashes that are associated with this
disease, particularly those associated with disseminated cutaneous Lyme. Early diagnosis
of the disseminated forms of Lyme is critical to prevent the occurrence of life-threatening
cardiovascular and neurological complications known to occur with this disease.
Keywords
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Article info
Publication history
Published online: October 19, 2020
Accepted:
August 2,
2020
Received in revised form:
July 19,
2020
Received:
April 21,
2020
Identification
Copyright
© 2020 Published by Elsevier Inc.
