Localized tick bite reaction.

A woman presented with a localized tick bite reaction. The tick (Amblyomma americanum, the "lone star" tick) was still attached to the erythematous, indurated skin of the upper back. After several unsuccessful attempts at removal, a punch biopsy was performed, and the resultant histologic sections incorporated both tick and involved skin. The various systemic and localized tick bite reactions are discussed, as are the diagnostic dilemmas which may arise when the organism is no longer present. Punch biopsy is suggested as an effective means of removing the organism.