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JAMA Diagnostic Test Interpretation
April 26, 2016

Lyme Disease Serology

Author Affiliations
  • 1Divisions of Pediatric Infectious Diseases & General Internal Medicine, Duke University School of Medicine, Durham, North Carolina
  • 2The Sherrilyn and Ken Fisher Center for Environmental Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
  • 3Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Ft Collins, Colorado
JAMA. 2016;315(16):1780-1781. doi:10.1001/jama.2016.4882

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.

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