[Multilocular erythema migrans in borreliosis]

Area of Science:

• Pediatric infectious diseases
• Dermatology
• Vector-borne illnesses

Background:

• Borreliosis is the most common childhood vector-borne disease.
• Erythema migrans occurs in 80% of cases, but multilocular lesions are rare (2-18%).
• Differential diagnoses include erysipelas, insect bite reactions, and drug eruptions, especially without a clear tick bite history.

Observation:

• A 5-year-old boy presented with nine erythema migrans lesions on his face, trunk, arms, and legs.
• The patient reported a tick bite three weeks prior to presentation.
• Lesions were characterized by central pallor.

Findings:

• Serological tests confirmed an acute Borrelia burgdorferi infection.
• Oral amoxicillin treatment led to the resolution of skin manifestations within three days.
• No signs of persistent borreliosis were observed during a six-month follow-up.

Implications:

• Multilocular erythema migrans represents a disseminated early Lyme disease infection.
• This manifestation can be associated with systemic symptoms like malaise, arthritis, carditis, headache, and meningeal signs.
• Antibiotic therapy is crucial; intravenous administration is preferred for systemic involvement.