Case report: Misdiagnosed erythema migrans

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Case report: Misdiagnosed erythema migrans

Post by dlf » Tue 6 Oct 2015 16:18

Interesting photographs in the full text version!

Dermatol Online J. 2015 Aug 15;21(8). pii: 13030/qt9cs1x7r5.
Vesicular erythema migrans: an atypical and easily misdiagnosed form of Lyme disease.
Mazori DR1, Orme CM, Mir A, Meehan SA, Neimann AL.
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.
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Re: Case report: Misdiagnosed erythema migrans

Post by ChronicLyme19 » Wed 7 Oct 2015 1:51

OOO thanks for posting, I'm always looking for pictures of atypical rashes to put up on our city's page.
Half of what you are taught is incorrect, but which half? What if there's another half missing?

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Re: Case report: Misdiagnosed erythema migrans

Post by inmacdonald » Thu 8 Oct 2015 14:58

Failure to Diagnose ; Death be not Proud

A 19 month old boy died last week in hospital , Manassas Virginia.
Can you discern the actual cause of his death?

His physicians were mystified and had no definite diagnosis:
Erythema migrans annotated Infant  Deathat 19 months.png
If you cannot see this as Erythema Migrans, god help your patients
Erythema migrans annotated Infant Deathat 19 months.png (302.08 KiB) Viewed 1144 times

Alan B. MacDonald, MD, FCAP
October 7,2015

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