A 10-year-old girl developed an annular skin lesion on her anterior neck. The lesion, initially attributed to a bug bite by her mother, enlarged and developed central clearing. The patient lived in North Carolina with no recent travel or known tick bite. She had no symptoms other than mild local itching. After several weeks, the patient’s mother applied over-the-counter topical antifungal cream and the lesion faded. After 10 days of antifungal therapy, the patient was evaluated by her pediatrician. Examination results were normal except for a 2.0-cm annular lesion with central clearing and peripheral flaking (Figure). The pediatrician ordered serologic testing for Lyme disease, prescribed 14 days of doxycycline based on the results (Table), and referred the patient to an infectious disease specialist for evaluation.
Lantos PM, Auwaerter PG, Nelson CA. Lyme Disease Serology. JAMA. 2016;315(16):1780-1781. doi:10.1001/jama.2016.4882