Clinical Images  |   May 2012
Erythema Chronicum Migrans
Author Notes
  • From the family medicine department at the Mayo Clinic in Rochester, Minnesota 
  • Address correspondence to Daniel H. Chappell, DO, 200 First St SW, Rochester, MN 55905-0001. E-mail:  
  •    Editor's Note: Unseasonably warm temperatures have caused early tick activity in several regions of the country this spring, putting individuals at increased risk for tick-borne diseases. For information on tick activity in your area, contact your state's department of health.
Article Information
Cardiovascular Disorders / Imaging / Clinical Images
Clinical Images   |   May 2012
Erythema Chronicum Migrans
The Journal of the American Osteopathic Association, May 2012, Vol. 112, 308. doi:
The Journal of the American Osteopathic Association, May 2012, Vol. 112, 308. doi:
An 18-year-old man with developmental disability presented with a circular, erythematous red rash (pictured) with central clearing that measured 5 cm in diameter. The rash developed on his abdomen 9 days after his father removed a small tick from the area where the rash appeared. His parents were unaware of how long the tick had been attached. The patient had several recent outdoor exposures while travelling in Minnesota. He denied fever, chill, headache, neck stiffness, myalgia, arthralgia, fatigue, or pruritus. 
Early Lyme disease was diagnosed on the basis of erythema chronicum migrans and exposure in an endemic area. The patient was prescribed doxycycline (100 mg twice daily for 21 days). The rash slowly improved, and no other symptoms occurred. 
   Financial Disclosures: None reported.
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DePietropaolo DL, Powers JH, Gill JM. Diagnosis of Lyme disease. Am Fam Physician. 2005;72(2):297-304. [PubMed]