Atypical Erythema Migrans in Patients with PCR-Positive Lyme Disease
Steven E. Schutzer , Bernard W. Berger, James G. Krueger, Mark W. Eshoo, David J. Ecker, and John N. Aucott
Author affiliations: University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark, New Jersey, USA (S.E. Schutzer); Private Dermatology Practice, Southampton, New York, USA (B.W. Berger); Rockefeller University, New York, New York, USA (J.G. Krueger); Ibis Biosciences Inc., Carlsbad, California, USA (M.W. Eshoo, D.J. Ecker); The Johns Hopkins School of Medicine, Baltimore, Maryland, USA (J.N. Aucott)
Figure. . Atypical erythema migrans lesion on a patient with PCR-positive result for Borreliaburgdorferi infection. The rash was not considered typical because it lacked central clearing and peripheral erythema. The differential diagnosis included a contact dermatitis and arthropod bite. At the initial examination, this patient was seronegative for B. burgdorferi by 2-tiered criteria. Three weeks after therapy, the patient had positive results for ELISA and IgM Western blot and negative results for IgG Western blot, providing evidence of seroevolution (i.e., increasing antibody titer and/or increase in band intensity or appearance of new antigen bands to B. burgdorferi).
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