LAUSR

A ‘tick bite’ would strongly suggest the diagnosis of the patient. A serology confirmed ‘Lyme disease’ (Borrelia IgG positive by ELISA and Western blot techniques). According to timing after bite (between 3 and 12 weeks) and manifestations (multiple erythema migrans (EM)), it was at ‘early disseminated stage’, and the patient received ‘amoxicillin for 21 days’. Cardiac and neurological involvement were ruled out. Most common clinical presentation includes EM (up to 89% of patients) at the site of the tick bite and flulike syndrome (fever, myalgia). EM usually looks like a bull’s-eye or a target, and some weeks later multiple EM can appear far from the place of the bite. Borrelia can also produce neurological involvement (unilateral facial palsy and meningitis) and cardiac affection (carditis, heart block). If no treatment is received, the patient can develop Lyme arthritis. Differential diagnosis of bull’s-eye lesions should include: ringworm, erythema multiforme, numular eczema and granuloma annulare. It is not thought that Lyme disease can be contracted in Australia or New Zealand.