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Late Diagnosis of Early Disseminated Lyme Disease: Perplexing Symptoms in a Gardener

Department of Family and Community Medicine (BES, AS, JS), Thomas Jefferson University, Philadelphia, PA
Division of Geriatrics (BES), Thomas Jefferson University, Philadelphia, PA

Correspondence: Corresponding author: Brooke E. Salzman, MD, Department of Family and Community Medicine, Division of Geriatrics, Thomas Jefferson University, Philadelphia, PA 19107 (E-mail: brooke.salzman{at}jefferson.edu)

The timely diagnosis of early disseminated Lyme disease presenting as multiple secondary erythema migrans lesions is sometimes delayed because this stage is infrequently encountered in a general practice. We report a case of a 60-year-old woman whose initial complaints of an erythematous, "burning" rash and flu-like symptoms led to several laboratory tests with no specific diagnosis. The correct diagnosis was only made after sorting through other possibilities in the differential diagnosis. By reproducing the medical images and reviewing the medical literature, we underscore the importance of including Lyme disease in the list of diagnoses pertaining to diffuse skin rashes in the febrile patient.

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