The Expansion of Lyme Disease: A Case of Infection in the Absence of Known Exposure

Abstract

Lyme disease is a systemic infection caused by the spirochete Borrelia burgdorferi often carried by the Ixodes tick. It is associated with dermatologic manifestations, most notably the “bullseye rash” of erythema migrans. The disease can progress in stages to involve other organs such as joints, the heart, and the nervous system. Lyme disease continues to spread, with West Virginia (WV) cases increasing dramatically in the last 2 decades. As a result, physicians are likely to encounter this disease more often, making recognition and early treatment a top priority to prevent potentially dangerous sequelae. We present a case of a 60-year-old man who presented with multiple erythematous annular plaques and was subsequently diagnosed with Lyme disease. This case is unique because he had no known exposure to ticks, was treated for Lyme Disease, and subsequently developed a Jarisch- Herxheimer reaction (JHR).