Challenges in differential diagnosis of erythema migrans: Case reports
| Author | Affiliation | |
|---|---|---|
University Hospital Wishaw | GB | |
Vilkaitė- Kitovskė, Alina | Viešoji įstaiga Vilniaus universiteto ligoninė Santaros klinikos |
| Date | Volume | Issue | Start Page | End Page |
|---|---|---|---|---|
2024-04-24 | 41 | S2 | 25 | 25 |
Poster Abstracts, P042
Objectives: We aim to present 2 clinical cases of Lyme disease (LD) in children and review the presentation and differential diagnosis of erythema migrans (EM).
Method: Articles with the keywords “dermatological manifestations of Lyme disease” and “erythema migrans” were retrieved from the PubMed and Cochrane databases and analyzed.
Results: A 7-year-old female patient presented with eyelid psoriasis exacerbation and periorbital dermatitis. She was treated with pimecrolimus cream with positive results. At the follow-up visit, a mildly flaky macule was noted on the right cheek which appeared when she warmed up. The patient was diagnosed with allergic dermatitis. Two weeks later she developed joint pain, headache, and dizziness which led to the clinical diagnosis of LD. She was treated with amoxicillin for 21 days. Following the treatment, dizziness, joint pain, and general weakness remained. An 8-year-old male patient noticed a tick in September 2021 with no rashes during the observation period. A facial macule with central redness was noticed 2 months later. The patient was diagnosed with unspecified dermatitis and prescribed pimecrolimus cream with no effect. In February 2022 he tested positive for IgM antibodies to Borrelia burgdorferi. After 21 days of amoxicillin treatment the rash subsided, hyperpigmentation remained with negative serology. In literature the majority of reported instances involving the differential diagnosis of EM have been documented in adults, showcasing a diverse range of clinical presentations of EM.
Discussion: These cases highlight the importance of early diagnosis because untreated early disseminated or late LD can lead to complications, such as multiple EM, Lyme neuroborreliosis, arthritis, carditis or acrodermatitis chronica atrophicans within the following weeks or months. It also highlights the range of differential diagnoses to be considered when a patient presents with EM, such as erythema multiforme, erythema annulare centrifugum, tinea corporis, cellulitis, contact dermatitis, fixed drug reaction, insect bite reaction, and granuloma annulare.