Disseminated secondary erythema migrans: Typical and atypical presentation of a rare disease in India

Abstract

Lyme borreliosis is a multisystem disease transmitted by the bite of vector, Ixodes tick and caused by the strains of spirochete Borrelia burgdorferi sensu lato. The Centers for Disease Control and Prevention has listed it as a reportable disease since 1991. Although the three classical cutaneous manifestations are primary erythema migrans, borrelial lymphocytoma, and acrodermatitis chronica atrophicans, secondary disseminated erythema migrans is a rare presentation. Reported atypical erythema chronicum migrans (ECM) lesions include vesicles, erythematous papules, purpura, and lymphangitic streaks. We report a case of a female patient who was clinically, serologically, and histopathologically diagnosed as a case of Lyme disease (LD) with disseminated secondary erythema migrans with atypical edematous lesions. Only four confirmed cases of ECM have been reported in India before this report. The case highlights this atypical and rare presentation of LD in India.

Keywords

• borrelia
• doxycycline
• erythema chronicum migrans
• ixodes
• lyme disease