title: Late diagnosis of early disseminated lyme disease: perplexing symptoms in a gardener.
abstract: 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.
authors.affiliation: Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, PA 19107, USA. brooke.salzman@jefferson.edu
authors.forename: Brooke E
authors.initials: BE
authors.lastname: Salzman
authors.forename: Amber
authors.initials: A
authors.lastname: Stonehouse
authors.forename: James
authors.initials: J
authors.lastname: Studdiford
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015153:Blotting, Western; D003937:Diagnosis, Differential; D004318:Doxycycline / Q000627:therapeutic use; D004797:Enzyme-Linked Immunosorbent Assay; D015787:Erythema Chronicum Migrans / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D005260:Female; D051639:Gardening; D006801:Humans; D008193:Lyme Disease / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D008875:Middle Aged
chemical_list: D000900:Anti-Bacterial Agents; D004318:Doxycycline