Image in medicine
Chronic erythema migrans
Eritema crónico migrans
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Patient who presents with a 10-day history of asymptomatic erythematous skin lesion of centrifugal growth on the right thigh. He did not report fever or general symptoms and denied a history of bites. On examination, an oval macular lesion was observed on the anterior aspect of the right thigh, annular in shape, with a slightly raised erythematous border of an intense red colour and with clearer demarcation limits in the perilesional skin compared to the centre of the lesion (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). No pathological lymphadenopathies were palpated. Lab tests showed a subtle elevation of protein <span class="elsevierStyleSmallCaps">C</span> reactive values. With a clinical diagnosis of suspected erythema chronicum migrans, treatment was started with doxycycline 200 mg per day for 14 days. In addition, <span class="elsevierStyleItalic">Borrelia burgdorferi</span> serologies were performed.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">After 10 days, the primary lesion had resolved (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), obtaining serological confirmation, with elevated IgM and negative IgG.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Even in low endemicity areas, we must not forget to include Lyme borreliosis in the differential diagnosis of annular lesions. Patients often do not remember the history of the <span class="elsevierStyleItalic">Ixodes</span> tick bite due to its small size.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0020" class="elsevierStylePara elsevierViewall">This article has not received any type of funding.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interests</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflict of interests" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Castiñeiras González J, Varas Meis E, Rodríguez Prieto MÁ. 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