A novel presentation of Lyme disease rash

A novel presentation of Lyme disease rash

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Whereas Lyme disease is often related to a bull’s-eye rash, atypical displays can happen. Recognizing these distinctive appearances is crucial to an early prognosis and immediate remedy, particularly when serological testing for Lyme disease is unreliable.

Of their examine, “Atypical Lyme Disease Rash: A Case Report,” Khanna et al. describe the case of a 69-year-old girl, who examined unfavourable for Lyme disease (based on CDC standards), but introduced with an atypical Lyme rash.

“Our affected person solely had one band optimistic on Western blot testing, which isn’t thought of a optimistic end result.”

“Most clinicians acknowledge [Lyme disease] by the standard related bull’s-eye look of the erythema migrans (EM) rash. Nonetheless, a diagnostic problem happens when an alternate look for the rash is current,” the authors state.

In a examine of 69 individuals, who introduced to a medical middle in Wisconsin, an space endemic for Lyme disease, greater than 50% of the EM lesions had been homogeneous in colour and solely 6% exhibited the bull’s-eye look. And, in West Virginia solely 49% of instances had the EM rash, based on a 2021 examine.

Lyme disease rash: a novel look

The affected person, who resides in West Virginia, exhibited a rash with out the traditional outer ring or internal clearing as seen with EM rashes. She sought medical consideration for a purplish, itchy rash on her stomach, which appeared 6 days after a tick chunk. Lesions had been additionally current beneath each breasts, together with a number of smaller papules on the higher arm.

The purple coloring of the rash is exclusive. In keeping with one examine, solely 6% of EM rashes had been purple.

View rash images from study.

In West Virginia, 2021 knowledge revealed that solely 49% of instances had the EM rash.

Previous to testing for Lyme disease, the girl was handled empirically with doxycycline for 14 days. One week later, there was important enchancment of the rash with no further signs.

How acquainted are medical doctors with atypical displays of a Lyme disease rash? One examine discovered:

  • 25.7% of the members incorrectly recognized the uniformly purple EM
  • 43.6% incorrectly recognized the disseminated EM
  • 33.0% incorrectly recognized the blue-purple EM presentation

Authors conclude:

  • “Healthcare suppliers ought to keep a excessive index of suspicion of [Lyme disease] in sufferers with tick bites, even with out typical EM, to make sure early prognosis and remedy.”
  • “Training on numerous [Lyme disease] displays is essential for enhancing public well being outcomes.”


  1. Khanna S, Goebel LJ. Atypical Lyme Illness Rash: A Case Report. Cureus. 2024 Feb 23;16(2):e54779. doi: 10.7759/cureus.54779. PMID: 38529463; PMCID: PMC10961653.

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