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Comment
. 2014 Aug 14;371(7):684.
doi: 10.1056/NEJMc1407264.

Lyme disease

Eugene D Shapiro
Comment

Lyme disease

Eugene D Shapiro. N Engl J Med. .

Abstract

A 32-year-old pregnant woman from southeastern Connecticut presents to her physician in July at 26 weeks’ gestation because of a skin lesion. She reports she has had fatigue, arthralgia, and headache for 2 days and a rash in her left axilla for 1 day. She lives in a wooded area and works in her garden frequently. Six weeks earlier, she had removed a small tick that was attached behind her right knee. On physical examination, she is afebrile. She has an erythematous, oval macular lesion, 7 to 8 cm in diameter, in her left axilla, with enhanced central erythema; no other abnormalities are noted. How should her case be managed?

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Conflict of interest statement

Dr. Shapiro reports providing medical-record review for law firms for malpractice cases regarding Lyme disease. No other potential conflict of interest relevant to this article was reported.

Figures

Figure 1
Figure 1. Types of Erythema Migrans
Panel A shows a single erythema migrans lesion, Panel B shows vesicular erythema migrans, and Panel C shows multiple erythema migrans lesions.
See this image and copyright information in PMC

Comment on

  • Clinical practice. Lyme disease.
    Shapiro ED. Shapiro ED. N Engl J Med. 2014 May 1;370(18):1724-31. doi: 10.1056/NEJMcp1314325. N Engl J Med. 2014. PMID: 24785207 Free PMC article. Review.
  • Lyme disease.
    Castiglione TF. Castiglione TF. N Engl J Med. 2014 Aug 14;371(7):683. doi: 10.1056/NEJMc1407264. N Engl J Med. 2014. PMID: 25119622 No abstract available.
  • Lyme disease.
    Feder HM Jr. Feder HM Jr. N Engl J Med. 2014 Aug 14;371(7):683-4. doi: 10.1056/NEJMc1407264. N Engl J Med. 2014. PMID: 25119623 No abstract available.

References

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    1. Tibbles CD, Edlow JA. Does this patient have erythema migrans? JAMA. 2007;297:2617–27. - PubMed
    1. Steere AC, Sikand VK. The presenting manifestations of Lyme disease and the outcomes of treatment. N Engl J Med. 2003;348:2472–4. - PubMed

MeSH terms