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March 11, 1992

Current Perspective on Lyme Borreliosis

Author Affiliations

From the Epidemiology and Biometry Branch, Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md.

JAMA. 1992;267(10):1381-1383. doi:10.1001/jama.1992.03480100087037

SELECTED CASE  A 29-year-old woman presented with knee and elbow pain of 12 days' duration. Twelve weeks earlier in mid-June she had been working in a craft center at a camp on the Chesapeake Bay, Md, but spent much recreational time biking through wooded and open coastland. She recalled scratching a slightly pruritic area on herSee also p 1364. lower thigh in early July. Several days later she noticed a circular area of intense redness, approximately 8 cm in diameter, which she attributed to irritation from scratching. Over the next 10 days, the rash grew considerably larger, showing a red outer border more visible than the center. The rash then disappeared gradually. In late July, she felt unusually hot and fatigued, experienced headache and intermittent nausea for 5 days, and had difficulty sleeping and concentrating both at work and while biking. For about 36 hours she had mild pain