erythema chronicum migricans (erythema migrans)
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Etiology
- associated with early, localized Lyme disease (Borrelia burgdorferi)
- recurrent erythema migrans represents reinfection with a different genotype of Borrelia burgdorferi rather than relapse[3]
- Southern tick-associated rash illness
Epidemiology
- 80% of patients with Lyme disease
Clinical manifestations
- lesion develops subsequent to & surrounding the site of a tick bite
- incubation period 5-14 days
- annular, sometimes urticarial, erythematous lesion with central clearing[2]
- lesions are single (75%) or multiple (25%)
- lesions > 5 cm in size
- lesions expand over days, resolve over weeks
- systemic symptoms common & may be only manifestation
* images[5][6][7][8][9][10][11]
Laboratory
- no laboratory testing recommended[2]
- arguments for no testing in[2] less than convincing
- Borrelia burgdorferi DNA from skin biopsy
- Borrelia burgdorferi serology may be negative in early, localized Lyme disease
Differential diagnosis
- tick bite reaction:
- incubation period hours
- size: < 1 cm
- expands over hours, resolves over days
- systemic symptoms rare
- Streptococcal cellulitis
- progresses over hours
- very tender
- patients often very ill
- burn (history)
- fixed drug eruption (history)
- dermatophyte infection
- necrotic spider bite (endemic areas)
Management
- see Lyme disease
- empiric oral therapy 14-21 days, regardless of cause[2] (however, it would seem prudent to determine the cause)
- 1st line agents
- doxycycline 100 mg PO BID
- amoxicillin 500 mg PO TID
- cefuroxime 500 mg PO BID
- alternative agent: azithromycin 500 mg PO QD
- intravenous ceftriaxone for cardiac or neurologic manifestations or evidence of disseminated Lyme disease
- 1st line agents
More general terms
Additional terms
References
- ↑ Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 176
- ↑ 2.0 2.1 2.2 2.3 2.4 Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17, 18. American College of Physicians, Philadelphia 2009, 2012, 2015, 2018.
- ↑ 3.0 3.1 Physician's First Watch, Nov 15, 2012 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org
Nadelman RB et al. Differentiation of reinfection from relapse in recurrent Lyme disease. N Engl J Med 2012 Nov 15; 367:1883
Steere AC. Reinfection versus relapse in Lyme disease. N Engl J Med 2012 Nov 15; 367:1950 - ↑ Stonehouse A, Studdiford JS, Henry CA An update on the diagnosis and treatment of early Lyme disease: "focusing on the bull's eye, you may miss the mark". J Emerg Med. 2010 Nov;39(5):e147-51. Epub 2007 Oct 18. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17945460
- ↑ 5.0 5.1 Wikipedia: Erythema chronicum migrans (image) https://en.wikipedia.org/wiki/Erythema_chronicum_migrans
- ↑ 6.0 6.1 MedicineNet.com Picture of Lyme Disease (Erythema-Migrans) http://www.medicinenet.com/image-collection/lyme_disease_erythema-migrans_picture/picture.htm
- ↑ 7.0 7.1 Centers for Disease Control and Prevention (CDC) Signs and Symptoms of Untreated Lyme Disease. http://www.cdc.gov/lyme/signs_symptoms/
- ↑ 8.0 8.1 Blanton L, Keith B, Brzezinski W. Southern Tick-Associated Rash Illness: Erythema Migrans Is Not Always Lyme Disease Medscape http://www.medscape.com/viewarticle/583023 South Med J. 2008;101(7):759-760. PMID: https://www.ncbi.nlm.nih.gov/pubmed/18580719
- ↑ 9.0 9.1 DermNet NZ. Lyme disease http://www.dermnetnz.org/bacterial/lyme.html
- ↑ 10.0 10.1 Burns DO 7 Bug Bites You Need to Know Medscape. June 17, 2021 https://reference.medscape.com/slideshow/bug-bites-6004328
- ↑ 11.0 11.1 Steele RW Lyme disease Medscape. June 15, 2022 https://reference.medscape.com/slideshow/tick-borne-illnesses-6006369