In this NEJM Image in Clinical Medicine, a man has periumbilical erythema and a small gray protrusion in the umbilicus.
Comment
The patient’s history of an expanding erythematous lesion, otherwise known as erythema migrans (EM), and the tick extraction are right on target for Lyme disease. Clinicians should know erythema migrans occurs in 70% to 80% of infected patients with Lyme disease. Two thirds of cases present as uniformly red or have enhanced central erythema without clearing as opposed to the often described “bullseye rash.” The lesion generally occurs up to 2 weeks after the tick bite and is not always associated with systemic symptoms. Don’t miss the mark; EM itself is spot-on for Lyme disease if you are in a tick endemic region.
Comment
The patient’s history of an expanding erythematous lesion, otherwise known as erythema migrans (EM), and the tick extraction are right on target for Lyme disease. Clinicians should know erythema migrans occurs in 70% to 80% of infected patients with Lyme disease. Two thirds of cases present as uniformly red or have enhanced central erythema without clearing as opposed to the often described “bullseye rash.” The lesion generally occurs up to 2 weeks after the tick bite and is not always associated with systemic symptoms. Don’t miss the mark; EM itself is spot-on for Lyme disease if you are in a tick endemic region.