Mazori Daniel R, Orme Charisse M, Mir Adnan, Meehan Shane A, Neimann Andrea L
The Ronald O. Perelman Department of Dermatology, New York University School of Medicine.
Dermatol Online J. 2015 Aug 15;21(8):13030/qt9cs1x7r5.
Erythema migrans is the initial sign in the majority of patients infected with Borrelia, the genus of spirochetes that causes Lyme disease. Early identification and treatment decrease the risk of progression to later stages of disease. Although a "bull's eye" appearance owing to lesional clearing is considered classic for erythema migrans, this feature is surprisingly often lacking among patients in the United States. Furthermore, cutaneous Lyme disease can exhibit a wide range of morphologic variability in a minority of patients. Herein, we describe the case of a patient with Lyme disease in which the presence of atypical vesicular features, in conjunction with the initial absence of clearing, resulted in multiple misdiagnoses and delayed treatment. We also review the literature on the epidemiology and management of erythema migrans for cases in which the diagnosis may pose a challenge.
游走性红斑是大多数感染博氏疏螺旋体（一种导致莱姆病的螺旋体属细菌）患者的初始体征。早期识别和治疗可降低疾病进展至后期阶段的风险。尽管由于病灶消退而呈现的“靶心”外观被认为是游走性红斑的典型表现，但令人惊讶的是，在美国患者中这种特征常常缺失。此外，在少数患者中，皮肤型莱姆病可呈现出广泛的形态学变异。在此，我们描述了一例莱姆病患者的病例，该患者存在非典型水疱特征，且最初并无病灶消退，导致多次误诊和治疗延误。我们还回顾了关于游走性红斑流行病学和管理的文献，以应对诊断可能具有挑战性的病例。
