Erythema Migrans Empty Line Calibri Size 12 Empty Line Calibri Size 12

Daniel Polvino, Grant Wei
History of present illness: A 28-year-old male presented to the emergency department with a chief complaint of two weeks of headache, chills, and numbness in his hands. He reported removing a tick from his upper back approximately two weeks ago, but did not know how long the tick had been embedded. His review of symptoms was otherwise unremarkable. Significant findings: On physical examination, an 8-cm non-raised, erythematous lesion with central clearing was noted on the right posterior
more » ... A small scab was located at the center of the lesion with no evidence of retained tick. No other rashes were present. Discussion: Lyme disease is a tick-borne illness caused primarily by the spirochete Borrelia burgdorferi. Ticks must be attached for a minimum of 48 hours in order to transmit the spirochete. 1 Erythema migrans (EM) is the most common clinical manifestation of Lyme disease. EM is characterized by a slowly-expanding erythematous rash at the site of the tick bite, typically appearing between 7 and 14 days following tick attachment. Rashes range from 5cm to 30cm and may develop central clearing. 2 EM must be differentiated from initial erythema at the site of the bite due to a reaction to tick saliva. The differential includes southern